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Use of Mental Health Services After Hurricane Floyd in North Carolina

The aim of this study was to examine the impact of a natural disaster, Hurricane Floyd, on the use of mental health services in a Medicaid population in North Carolina. Difference-in-differences techniques were used to determine month-by-month and 12-month postevent average effects of the hurricane on the use of mental health services at the county level. The exposure group was drawn from 14 severely affected counties, and the control group was drawn from 56 unaffected counties. Data were analyzed from July 1998 (14 months before the hurricane) to September 2000 (12 months after the hurricane). The number of per-enrollee per-month outpatient visits to psychologists or licensed clinical social workers and the number of outpatient visits to non-mental health specialists showed a statistically significant increase over the 12-month postevent period, whereas the number of inpatient admissions for behavioral health reasons decreased. Dollars spent on antianxiety medication per enrollee per month showed a statistically significant decrease. The aftermath of Hurricane Floyd was associated with significantly greater use of mental health services in the Medicaid community in North Carolina for a few services. However, it is unclear whether changes in utilization patterns were due to the greater demand for services or to the availability of other services that may have served as substitutes. The results of this study underscore the importance of planning for service implementation and delivery after similar events in other states.

Hospital systems. Data sources, bed supply and performance in hospital systems. An Anglo-Czechoslovak comparison

Background: There were a number of similarities, except for their effectiveness, in the health care systems of Czechoslovakia and England and Wales between the Second World War and the late 1980s. In a comparison of Czechoslovakia with England and Wales, the objectives of this study were to examine data sources and to report time trends and regional distributions in hospital bed supply, hospital doctor supply and hospital utilisation. Methods: For the specialties of general medicine and general surgery in both countries from 1960 to 1986, data were collated on bed supply, hospital doctor supply, discharge rates and length of stay. Issues concerning the comparability of the data were addressed, for example those of the definitions of specialty, length of stay and casemix. Results: In the period 1960 to 1986, in the specialties of general medicine and general surgery, there was a relative excess in the supply of hospital doctors and beds in Czechoslovakia compared with England and Wales. Hospital performance in terms of discharge rates, discharges per bed and length of stay remained relatively static in Czechoslovakia during this period compared to marked increases in discharge rates and reduced length of stay in England and Wales. Both countries recorded reductions in the regional variation of bed and doctor supply and hospital utilisation. Conclusions: International studies of hospital utilisation need to be interpreted carefully in the light of definitions of hospital stay, casemix, the use of day cases and the availability of other services. Subject to these caveats, discharge rates were high and duration of stay long In Czechoslovakia compared with England and Wales; however, both countries achieved important improvements in regional equity.

Pediatric emergency department utilization in the 1970s

An analysis was undertaken of 8.470 visits to a pediatric emergency department (ED) over a three-month period during 1975–1976. The ED was busiest in the evening and on weekends. Visits were overwhelmingly for acute conditions, which varied seasonally. Very young children accounted for a large proportion of visits (22.3% < 1 year old, 47.0% < 3 years old). The proportion of very young children increased as the hour of day got later. Overall, 7.3% of visits resulted in admission to the hospital, and 10% of children less than 1 year old were admitted. Admission rates were significantly higher on the day and night shifts than in the evenings, and rates were higher on weekdays than on weekends. Visits were mainly by children living in areas near the hospital, and children from the most distant areas were significantly more likely to be admitted than those from the nearest areas. The authors conclude that the documented ED usage patterns reflect the conditions of the children seen (age, medical problems, and severity of illness) and diminished availability of other services on weekends and evening. This indicates reasonable utilization of medical services and suggests the need for non-ED sources of care at times of peak ED use. These ED usage patterns in the 1970s are similar to those described in the 1960s, and together with the earlier data they provide a basis for comparison of utilization patterns during the current period of rapidly changing health-service reimbursement schemes.