Research

The Mental Health Services Act

In November 2004, the citizens of California voted to initiate a transformation of the State's mental health system by passing Proposition 63, to increase funding for the system by a new 1% tax on adjusted gross incomes over $1 million. A paper in Health Affairs by Prof. Richard Scheffler and Dr. Neal Adams, "Millionaires and Mental Health: Proposition 63 in California," found that homelessness was a major factor in its passage. In 2008, researchers at the Petris Center will be continuing their study, The Impact of Proposition 63 on the Financing and Delivery of Mental Health Programs in California. This study is supported by funding from the California Health Care Foundation, an independent philanthropy based in Oakland, California. The study monitors the flow of funds and changes in programs and services, analyzes the process of change, and examines the impact of changes on important social indicators. The Petris Center's work on the mental health system in California includes "California on the Eve of Mental Health Reform" which provides unique baseline information on county mental health systems on topics such as finances, staffing patterns, organization structures and information technology.

Related Publications

[Back To Top]

California's Mental Health System

In 1991, the California legislature enacted a plan, called "Program Realignment," to decentralize the state mental health system and gave more flexibility and control to the 58 county operated mental health care systems. This significant change in the financing structure provided both incentives and risks to local mental health authorities. The study reported in the "State Health Care Reform: The Effects of Program Realignment on Severely Mentally Ill Persons in California's Community-Based Mental Health System" examined how access to, utilization of, and cost of community-based mental health services changed during the realignment period in relation to patients' needs.

Another report, "The Impact of Realignment on the Client Population in California's Public Mental Health System" examined whether decentralization of California's public mental health system under program realignment has changed the composition of the client population, with greater attention toward inclusion of persons with a severe mental illness. According to "The Impact of Realignment on Utilization and Cost of Community-Based Mental Health Services in California", the overall utilization and cost of community-based mental health services dropped significantly after the implementation of realignment.

The increased local control created through program realignment gives the system the flexibility to address the widely varying levels of mental health indicators that exist in each county, as found in the Petris Center's 2004 report, "Measuring Mental Health in California's Counties: What Can We Learn?" [PDF]

For information on California's mental health workforce, see the Petris Center research published in 2003 in Health Affairs entitled "The Occupational Transformation of the Mental Health System".

Related Publications

[Back To Top]

California Health Reform

In early 2007, Governor Schwarzenegger unveiled his health reform proposal for California. In November, the Petris Center and The Berkeley Center for Law, Business and the Economy jointly held a conference, "California's Proposed Health Care Reform: The Legal and Economic Implications," at UC Berkeley. Under the governor's plan, the individual mandate requires individuals to obtain insurance coverage, and insurers must issue health insurance coverage to all applicants, also known as guaranteed issue. An individual's insurance premium would be based on modified community rating, which allows for premiums to vary based on the individual's age and geographic area, but not on the individual's health status. Hence, insurers will have an incentive to try to avoid covering individuals with expensive preexisting conditions. At the conference, Petris Center researchers presented evidence showing that insurance firms will have a large incentive to avoid covering high-risk individuals even when the firms would receive a subsidy for a portion of the costs of their most expensive enrollees. This type of risk adjustment is known as reinsurance. Additional research showed that a more general risk adjustment scheme would be more effective in reducing this incentive (Dow, Fulton, and Baicker, working paper).

Related Publications

  • Reinsurance for High Health Costs: Benefits, Limitations, and Alternatives
    — Dow, W.H., B. D. Fulton, and K. Baicker. The Nicholas C. Petris Center Working Paper.
[Back To Top]

California's Workforce Studies

Petris Center research shows that California's current supply of physicians is adequate; but, unequal distribution contributes to the inaccessibility of California's health care system for disadvantaged populations. Petris Researchers found that the state's total supply of physicians is now on par with the rest of the U.S. Yet, some non-metropolitan counties with lower per capita incomes and higher populations of Hispanics have persistent shortages of physicians. Strong evidence was discovered that there is an economic value to racial and ethnic diversity in the physician workforce, suggesting that a more diverse workforce creates more consumer welfare. Researchers also found that the physician workforce lacks the racial/ethnic diversity of the state's population. The work found that while black and Hispanic physicians are disproportionately less likely to leave areas where they are underrepresented in comparison to white and Asian physicians, only black physicians just completing their residencies and moving to active patient-care physician status are more likely to move to such areas. These findings will be summarized as part of Prof. Scheffler's newest book, Is There a Doctor in the House? Market Signals and Tomorrow's Supply of Doctors (Stanford University Press, September 2008).

Related Publications

[Back To Top]

Pharmaceuticals

Prescription drug costs are the fastest growing segment of national health care expenditures. The Petris Center has studied this issue in two different areas: attention-deficit/hyperactivity disorder (ADHD) and access to prescription drugs for the uninsured. ADHD is one of the most commonly diagnosed behavioral disorders in children. Approximately 8% of U.S. children aged 4-17 have been diagnosed, of whom, approximately 60% use prescription medication, primarily stimulants, to treat the disorder. The Petris Center is currently completing work funded by a three-year grant from the National Institute of Mental Health: An Economic and Policy Analysis of ADHD and Stimulant Drugs. The purpose of this research is to better understand economic and social factors that affect diagnostic and medication use patterns in California and nationwide. Petris Center researchers found that ADHD diagnostic prevalence is lower among black and Hispanic children as compared to otherwise demographically similar white children; and among diagnosed children, found that medication use is lower among black children as compared to otherwise demographically similar white children (Scheffler et al., working paper). Further research is being conducted to understand the reasons for these disparities, including investigating parent, school, and health professional decisions. This is especially important to California, given its large Hispanic population. In another area of ADHD research, Petris Center researchers found a positive relationship between a child who initiated medication during a given school year and his/her mathematics and reading test score gains; however, in subsequent years the mean test score gains for medicated versus unmedicated status did not differ significantly (Scheffler et al., working paper). Further research will be conducted with another wave of data to better understand the long-term relationship between medication usage and a child's academic achievement. In a related forthcoming study in Teachers College Record, Petris Center researchers found children in schools with higher levels of ADHD clustering had lower reading achievement scores than children in schools without this characteristic (Stone et al, forthcoming).

The Petris Center has also studied programs designed to improve access to prescription medications, "Uninsured Californians and Access to Prescription Drugs". This report provided estimates of number of uninsured in each state, described their demographic characteristics, and reviewed pharmaceutical company and government programs designed to improve their access to prescription medications.

Related Publications

[Back To Top]