ABSTRACT
A quasi-experimental method was developed to evaluate the cost-effectiveness of a public system of 24-hour acute psychiatric care in Santa Clara County, California, before and after a new treatment setting was introduced. The original system relied on a 54-bed psychiatric unit in a county general hospital; the new system consisted of a 20-bed unit in the general hospital plus a 45-bed nonhospital psychiatric health facility. The study demonstrated that the per diem cost of the psychiatric health facility was approximately 60 percent that of the original general hospital unit, but the average difference in cost per episode between the two systems was only about +25, primarily due to longer lengths of stay in the new system. In addition, patients treated in the new, combined system appeared sicker at discharge than those treated in the old system. The findings suggest the importance of simultaneously evaluating both cost and treatment effectiveness to make sure that one element does not dominate program direction at the expense of the other.
Subject(s)
Mental Disorders/therapy , Psychiatric Department, Hospital/economics , Residential Facilities/economics , Acute Disease , Adjustment Disorders/therapy , Adult , California , Cost-Benefit Analysis/methods , Female , Humans , Length of Stay/economics , Male , Mood Disorders/therapy , Schizophrenia/therapyABSTRACT
The psychiatric health facility (PHF) is a new kind of California health facility licensed for psychiatric inpatient treatment. PHFs provide acute short-term treatment in nonhospital settings that have more flexible facility and staffing requirements than do hospitals. The enabling legislation states that the average per diem cost should be approximately 60 percent of the cost of similar services provided in a general hospital. In late 1985 one private and 16 public PHFs were operating in California. The number of applicants wishing to open private-sector PHFs continue to increase, partly due to recently mandated insurance coverage for the facilities. Data on existing PHFs show that the characteristics of patients in PHFs and general hospitals are similar, and that state hospital utilization for counties using PHFs is lower than for non-PHF counties.
Subject(s)
Community Mental Health Services/organization & administration , Mental Disorders/therapy , Residential Facilities/organization & administration , Acute Disease , California , Community Mental Health Services/legislation & jurisprudence , Cost Control/trends , Humans , Licensure , Reimbursement Mechanisms/trends , Residential Facilities/legislation & jurisprudenceABSTRACT
The author reviews the decision made by the California Supreme Court in the case of Tarasoff v. the Regents of the University of California, et al., which stipulated that therapists must warn authorities specified by law as well as potential victims of possible dangerous actions of their patients. He states the basic points of the Northern California Psychiatric Society's amicus curiae brief on behalf of the university regents and discusses the issues raised by the Tarasoff decision vis--53a-vis the mental health profession and its dealings with potentially violent individuals.
