The political-economics of privatizing mental health: A study of the relationships between ownership of mental health clinics with professional advocacy and client creaming
This study examines the relationships among legal ownership (governmental, nonprofit, and proprietary) professional reports of advocacy on behalf of clients, client reductions in services for clients unable to pay, and client terminations for clients unable to pay. Executives in 73 licensed mental health clinics responded to semi-structured questionnaires administered in an interview format, and 605 master and doctoral level professionals responded to questionnaires. Privatization is the context for the study. Political-economic theory provides the framework for the study. The study discusses the methodological problems of empirically investigating propositions in the privatization debate, and the problems involved in operationalizing classifications of organizations. The study operationalizes dimensions of polyarchial and market influence on organizational behavior by using legal ownership and funding sources. Professionals responded to items comprising an advocacy scale measuring the amount of time they engage in a list of advocacy activities within the agency and within the community on behalf of clients on their caseloads. Professionals also responded to items on a disposition scale identifying the percentage of clients on their caseloads who receive reduced services or are terminated from services when they become unable to pay previously agreed-upon fees. Demographic data used in the study include: gender, age, professional degree, education, professional experience, clinic experience, and income. Additional data include hours worked per week and hours of face-to-face contact with clients per week. Data were analyzed using analysis of variance and regression techniques. Although the study found that types of clinic ownership do distinguish between professionals' reports of advocacy, service reductions, and service terminations, fee-for-service funding was found to be a more powerful predictor of differences in professionals' reports than were the other variables included in the study. Small clinic size and fee-for-service funding were found to be more powerful predictors of service reductions. The study also found that most of the control variables differed by legal ownership of the clinics. Implications for social welfare policy and recommendations for further research are offered.
Health Sciences, Mental Health, Economics, General, Political Science, Public Administration, Sociology, Public and Social Welfare, Health Sciences, Health Care Management
University of Illinois - Urbana-Champaign
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University of Illinois at Urbana-Champaign