This paper examines the changing role of the state psychiatric hospital as the country's state hospital population has declined 95 percent over 50 years.  The authors discuss the forces shaping public mental hospitals, the challenges they face, and their potential role in a new mental health care system.   

Fisher, W. H., J. L. Geller, et al. (2009). The changing role of the state psychiatric hospital. Health Affairs, 28(3), 676-84. DOI: 10.1377/hlthaff.28.3.676 http://content.healthaffairs.org/cgi/content/abstract/28/3/676 

Authors: William H. Fisher, Jeffrey L. Geller, John A. Pandiani. 

This article examines the effects of economic policy on the provision of psychiatric hospital care.  The authors discuss the shift from long-stay public hospitals to private acute care and the cost shifting from states to federal and private payers through managed care.  The authors note that the result has been a shortage of psychiatric beds but also a better continuum of care, increased specialization within hospital psychiatry units, and an increased emphasis on patient choice and recovery.  

Sharfstein, S. S. and F. B. Dickerson (2009). Hospital psychiatry for the twenty-first century. Health Affairs, 28(3), 685-8. DOI: 10.1377/hlthaff.28.3.685 http://content.healthaffairs.org/cgi/content/abstract/28/3/685 

Authors: Steven S. Sharfstein, Faith B. Dickerson.

This article estimates health-care demands by calculating expected end-of-year prices and incorporating them into a zero-inflated ordered probit model applied to several overlapping panels of data from 1996 to 2003.  The authors found that the price responsiveness of ambulatory mental health treatment has decreased substantially and is now slightly lower than physical health treatment, suggesting that concerns over moral hazard alone do not warrant less generous coverage for mental health. 

Meyerhoefer, C. D. and S. H. Zuvekas (2009). New estimates of the demand for physical and mental health treatment. Health Economics. [epub ahead of print] http://www.ncbi.nlm.nih.gov/pubmed/19350688 

Using simulated bill paying and data from MarketScan and an employer health benefit survey, this study examines examines trends in comprehensiveness of coverage, out-of-pocket spending for medical services, underinsurance, and the afford ability of employer-based insurance from 2004 to 2007.  The study finds that health plans covered slightly fewer expenses in 2007 than in 2004 and that out-of-pocket spending grew by more than 33 percent owing largely to growth in overall spending. The study found that the increased costs significantly affected those earning up to 200 percent of the federal poverty level (FPL). 

Gabel, J. R., R. McDevitt, et al. (2009). Trends in underinsurance and the afford ability of employer coverage, 2004-2007. Health Affairs, 28(4), w595-w606. DOI: 10.1377/hlthaff.28.4.w595 http://content.healthaffairs.org/cgi/content/abstract/28/4/w595 

Authors: Jon R. Gabel, Roland McDevitt, Ryan Lore, Jeremy Pickreign, Heidi Whitmore and Tina Ding

This article shows that, in spite of the increasing similarities between mental health care and general health care delivery and financing, important differences remain in patterns of spending growth.   

Frank, R. G., H. H. Goldman, et al. (2009). Trends in mental health cost growth: an expanded role for management? Health Affairs, 28(3), 649-59. DOI: 10.1377/hlthaff.28.3.649 http://content.healthaffairs.org/cgi/content/short/28/3/649 

Authors: Richard G. Frank, Howard H. Goldman, Thomas G. McGuire.

This paper addresses the following key questions: (1) How much was spent in the United States to provide M/SU treatment in 2001? (2) How were the expenditures for M/SU distributed by payer and provider type? (3) How did spending change from 1991 to 2001? (4) How did M/SU spending compare with spending for all U.S. health care?

The report finds that public payers began to bear a growing share of spending for mental health and substance abuse treatment. 

Download the full report (PDF): Trends U.S. Spending for Mental Health and Substance Abuse Treatment, 1991-2001 the Decline in Receipt of Substance Abuse Treatment by the Privately Insured, 1992-2001.pdf (117.68 kb)