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Josefina Irigoyen is a 2014 graduate of the PsyD Program in Clinical Psychology at Antioch University, New England

Keywords

mental health disparity, Texas mental health, Latino mental health, medicaid mental health expenditures, psychiatric inpatient treatment, continuum of care

Document Type

Dissertation

Publication Date

2014

Abstract

In 2009, Gawande published an article in The New Yorker that put the unknown mid-sized South Texas city of McAllen on the map. The article stated that McAllen was one of the most expensive health care markets in the country; it caused such media-frenzy that in a few days President Barack Obama (2009) began citing McAllen in his speeches for health care reform. Gawande concluded that overspending in the area was due to overutilization of medical services. The present study examined whether mental health services are overutilized based on archival data on McAllen's mental health services collected from Medicaid, Tropical Texas Behavioral Health (a McAllen area community mental health center [CMHC]), and The Behavioral Center at Doctors Hospital at Renaissance (a McAllen area private hospital). Findings yielded that diagnostic-related groups significantly impacted the average length of stay, as well as total costs for psychiatric inpatient treatment in McAllen, TX. Schizophrenia spectrum disorders required more days of treatment within the hospital than Bipolar disorders and further more days than Depressive disorders. Correspondingly, inpatient treatment of Schizophrenia spectrum disorders cost an additional $5,554.80 when compared to Bipolar disorders and $9,095.16 more than for Depressive disorders. Additionally, the readmission rate at Doctors Hospital was 26.72%, with nearly 1/4 of patients being readmitted at least once, and nearly 7% had 4 or more psychiatric hospitalizations within a one-year period. This readmission rate was higher than the national average perhaps because of inadequate after-care outpatient treatment in McAllen. Medicaid data showed that Texas consistently failed to contribute any state moneys to mental health spending; and that Massachusetts saw a considerably smaller increase in mental health expenditures over a 10-year period for both inpatient and outpatient services when compared to the United States as a whole (i.e., 26% vs. 260% for inpatient and 8% vs. 239% for outpatient, respectively). Furthermore, when compared to 2 reputable mental health care institutions (i.e., McLean Hospital and Brookline CMHC) in the Boston, Massachusetts area, McAllen''s continuum of care for mental health services fell short, with McAllen lacking considerably in step-down care and assessment.

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