SHIFTING THE RESPONSIBILITY FOR PAYMENT FOR STATE-HOSPITAL SERVICES TO COMMUNITY MENTAL-HEALTH AGENCIES

Objective: In 1990 the state of Arkansas shifted financial responsibil ity for state hospital services to community mental health centers; th rough a policy known as ''bed buy-back,'' centers now authorize all st ate hospital admissions and prospectively purchase bed days for their patients. Characteristics of patients hospitalized before and after im plementation of the policy were examined to determine how the policy a ffected hospital admission rates, types of patients admitted, and the amount of contact between CMHC and hospital staff about admitted patie nts, as well as how these elements were affected differently in rural and urban areas. Methods: Changes in the types of patients admitted ov er the 13 months before and 14 months after the change in financing we re studied through retrospective chart review of 648 patients. Adminis trative data were used to examine changes in numbers of admissions for 30 months before and 26 months afterward, Data were analyzed by piece wise regression, least squares, and logistic regression analyses. Resu lts: After financial decentralization, state hospital use was reduced in both urban and rural areas, although the reduction in urban areas w as proportionally greater, Contrary to expectation, admissions were no t limited to the most severely ill, disruptive, or substance-abusing p atients, nor were they more likely to be readmitted. For patients who were admitted, communication between the community and the state hospi tal was greater than before financial decentralization. Conclusions: S hifting financial responsibility for patient care significantly reduce d state hospital use, did not affect patient mix, and apparently incre ased coordination of care between community and hospital. Whether bed buy-back has affected the kind or quality of services delivered in the community awaits further study.