This is a study of the relationship between the ownership of hospitals and the extent and integration of hospital-based mental health care to the community and the mental health care system. """"""""Integration"""""""" will be characterized by (1) access to care, (2) continuity of care, (3) community participation in decisions and a hospital's accountability to community concerns, and (4) the economics and configuration of the hospital-based mental health care system. This project will examine three primary research questions: (1) Does the ownership form of the hospital (for-profit, private nonprofit or public) influence the location of the facility, patient and service mix, collaborative arrangements with other mental health care providers or public agencies or the hospital's pricing policies? (2) Does competition from proprietary hospitals alter the service and patient mix in public and private nonprofit hospitals, policies on admitting privileges for physicians, cooperative agreements among hospitals or preferred methods of contracting with public agencies? (3) Does affiliation with a multi-hospital system affect the resources devoted to assessing local community needs, involvement of community members and other local providers in the guidance of the hospital, resources devoted to aftercare for patients who have been discharged or relationships with state regulators? This project employs a two-stage research design. The first stage, a set of quantitative case studies of 14 hospitals in 3 local service areas in Massachusetts, is intended both to support the development of instruments for a nation-wide survey and to examine influences of ownership not readily studied through a survey. The second stage is a nation-wide survey of 250 local service areas. The survey provides a broad geographic base of information and can facilitate analyses of the interaction of ownership of hospitals with interstate variations in regulations and insurance coverage for mental health care.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Harvard University
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Schlesinger, M; Dorwart, R A; Epstein, S S (1996) Managed care constraints on psychiatrists' hospital practices: bargaining power and professional autonomy. Am J Psychiatry 153:256-60
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
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