Managing Competition in Public and Private Mental Health Agencies: Implications for Services and Policy

• Published in: The Milbank quarterly Vol. 72; no. 4; pp. 653 - 678
• Main Authors: Clark, Robin E., Dorwart, Robert A., Epstein, Sherrie S.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishers 01-01-1994; Published for the Milbank Memorial Fund by Cambridge University Press; Blackwell Publishing Ltd
• Subjects: Administrative agencies; Agencies; Community Mental Health; Community Mental Health Centers - economics; Community Mental Health Centers - organization & administration; Community Mental Health Centers - statistics & numerical data; Community mental health services; Comparison; Competition; Contract Services; Economic Competition; Federal aid; Fees; Health care; Health Policy; Health services; Humans; Insurance companies; Managed competition; Management; Management Styles; Medical practice; Mental health; Mental health insurance; Mental Health Services; Nonprofit organizations; Ownership; Politics; Private health care; Private sector; Privatization; Privatization - economics; Public health; Public Health Administration - economics; Public sector; Public Sector Private Sector Relations; Revenue; Social Values; U.S.A; United States; USA; United States
• ISSN: 0887-378X; 1468-0009
• DOI: 10.2307/3350359

The merits of public versus private health care agencies have been vigorously debated, particularly as states increasingly contract with community mental health agencies to serve people who need care. Management practices and performance in 452 public and private community mental health agencies in 49 states were examined to ascertain the impact of ownership on an agency's response to competitive pressures. Significant differences emerged in the use of management practices by public and private agencies to maximize efficiency and revenue, but not in measures of public orientation, such as provision of subsidized care. Competition from private practitioners increased the use of some management practices in both public and private agencies, but instituting management practices to increase efficiency and revenue did not affect the degree of public service. Ownership alone seems to predict management process better than it does public service orientation.