Suchergebnisse

THIS ARTICLE EXAMINES THE INTERSECTION BETWEEN FEDERAL PROGRAMMATIC GOALS AND STATE POLITICS IN THE ALLOCATION OF SUBSTANCE-ABUSE BLOCK-GRANT MONEY BY THE STATE OF MICHIGAN. THE ALCOHOL AND DRUG ABUSE AND MENTAL HEALTH SERVICES (ADMS) BLOCK GRANT ALLOWS STATES MORE FLEXIBILITY IN ALLOCATING "DRUG WARE" FUNDS. THE ADMS FORMULA DETERMINES THE AMOUNT OF MONEY GOING TO MICHIGAN BUT DOES NOT DETERMINE THE DISTRIBUTION OF FUNDS WITHIN THE STATE. AN EXAMINATION OF THE DISTRIBUTION OF ADMS FUNDING AMONG THE EIGHTEEN COORDINATING AGENCIES IN MICHIGAN FINDS THAT NEITHER THE STATE NOR THE NATIONAL FORMULAS DISTRIBUTE FUNDS IN A MANNER THAT REFLECTS SUBSTANCE-ABUSE DEATHS. MICHIGAN'S FORMULA PRODUCES A RESULT CONSISTENT WITH THE FEDERAL FORMULA, DESPITE THE SEPARATE STATE AND NATIONAL FORMULA NEGOTIATIONS. THE PROCESS IS NOT ONE OF BARGAINING OR EVEN COERCION; IT MAY BE DESCRIBED AS MUTUALLY INDEPENDENT DECISION-MAKING - OR PARALLEL POLICIES. MODELS OF INTERGOVERNMENTAL RELATIONS MUST BE REVISED TO INCLUDE THE POSSIBILITY OF JOINT SYNERGISTIC ACTION WITHOUT COORDINATION.

Psychiatric DRGs are identified in terms of their relative profitability within each hospital of a 386 hospital cohort. It is then determined whether hospitals admitted more of the more profitable and fewer of the less profitable patients over the period 1983-1987 (skimming). Also determined is whether hospitals discharged more of the less profitable to other short term hospitals over that same period of time (dumping). The findings generally indicate that this did not happen.