Does Closing Inpatient Beds in One Public Mental Health System Result in Increased Use of Hospital Services in Other Systems

Abstract

This study of users of Department of Veterans Affairs (VA) behavioral health services examines changes in their use of non-VA inpatient services from 1994 to 1997, a period of extensive VA bed closures. Data on service use were obtained on New York State residents who used VA behavioral health services and on residents who were hospitalized for behavioral health care at community general hospitals and state mental hospitals. Probabilistic population estimation, a novel statistical technique, was employed to evaluate the degree of overlap between VA mental health and non-VA inpatient populations without relying on person-specific identifiers. Annually, on average, 6% of VA behavioral health service users were hospitalized in either general hospitals in New York State or state mental hospitals: 4% of psychiatric patients, 10% of substance abuse patients, and 11% of dually diagnosed patients. Overall rates of cross system use did not change significantly from 1994 to 1997. Cross-system use of inpatient services is limited and was not affected by the closure of one-third of all VA mental health beds, most likely because of an increased supply of VA outpatient services.