This proposal for an ADAMM SDAC award will investigate economic influences on psychiatric provider behavior at the local service/market,area level and the implications for mental health services research and delivery. Providers will include psychiatric hospitals, community mental health centers and individual psychiatric practioners. Economic influences will include local area market factors (e.g.,-the supply of providers and services), sociodemographic characteristics of local areas (e.g., census data) and state economic and regulatory variables. The research will extend previous work on existing data bases: national surveys of psychiatric hospitals, community mental health centers and psychiatrists conducted in 1988. Using combined data bases, this research will seek to examine the effect on supply and supplier responses of demand-mediating variables. Provider behaviors of particular interest include those that might affect access and efficiency, such as changing ownership, changing the mix of services or patients (e.g., specialization), re-arranging relationships with other providers, or altering patterns of professional and treatment practices. Importantly, later stages of the research plan involve extensive work with new and original data concerning the need for psychiatric hospital services, geographic (area) variation in service utilization with patient-origin data and the supply and demand for specialty (e.g., substance abuse) services, using a statewide data set. Beginning with extensive survey data already available, the proposed principal investigator will also undertake advanced training in Harvard University's proposed doctoral-level program in health policy under the direction of Professor Joseph Newhouse. The overall goal will be to place the proposed mental health services research in a broader health policy context. The methodology will begin with analysis of facility-level survey data but will move in the direction of working with other large-sample data bases using econometric techniques (e.g., HIS mental health supplement data prevalence of major disorders and disability and state mental health authority rate-setting data). Further training will also focus on approaches to multidisciplinary, collaborative research in mental health health services with the potential for formulating mental health policy. The investigator will thereby seek to extend his prior training in clinical services and health management research in order to increase individual and institutional capabilities for independent research in a public policy research setting.
| Clark, R E; Dorwart, R A; Epstein, S S (1994) Managing competition in public and private mental health agencies: implications for services and policy. Milbank Q 72:653-78 |
| Dorwart, R A; Chartock, L R; Dial, T et al. (1992) A national study of psychiatrists' professional activities. Am J Psychiatry 149:1499-505 |
| Fisher, W H; Dorwart, R A; Schlesinger, M et al. (1992) The role of general hospitals in the privatization of inpatient treatment for serious mental illness. Hosp Community Psychiatry 43:1114-9 |
| Dorwart, R A; Schlesinger, M; Davidson, H et al. (1991) A national study of psychiatric hospital care. Am J Psychiatry 148:204-10 |
| Dorwart, R A (1990) Managed mental health care: myths and realities in the 1990s. Hosp Community Psychiatry 41:1087-91 |
