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PubMed1982

Legislating hospital bed reduction: the Michigan experience.

A variety of programs aimed at health care cost containment have been initiated at the state level. This article presents a case study of one state's effort to deal with health care cost issues, focusing on the formulation of adoption of legislation to reduce the number of hospital beds. The Michigan bed-reduction legislation was the creature of a coalition of powerful, organized "professional consumers" of health services who placed hospital cost containment on the political agenda and framed a solution. The provisions of the legislation were reshaped during the legislative process to grant concessions to a variety of interest groups, particularly the Michigan Hospital Association. Many additional criteria for determining excess bed capacity, some subjective, were added. Cost containment as a goal was, if not subordinated, at least made competitive with other goals--access to care, equity among types of providers, and quality of services. While the initial proposal was attractive as a seemingly simple extension of the certificate-of-need process within the existing regulatory framework, the legislation became increasingly complex in response to new issues raised by political actors who contributed to the shaping of the final version of the legislation. The formulation and adoption of Michigan's overbedding legislation appears to underscore what many other observers have noted: there are no purely technical solutions to health policy problems.

Certificate of Need↗
PubMed1984

Two decades of involuntary hospitalization legislation.

In 10 of the 13 cases the author examined, after passage of a state statute affecting involuntary admission to state psychiatric hospitals the percentage of involuntary admissions changed significantly in the direction intended by the legislature. The findings support the hypothesis that state laws significantly influence involuntary admission rates and, consequently, clinical practice. The findings also demonstrate that legislative intent in the late 1960s and early 1970s supported restriction of involuntary hospitalization and that a move toward liberalization of its use occurred in the late 1970s. The author recommends greater involvement by psychiatrists in the formulation of legislation that has an influence on their clinical work.

Attitude of Health Personnel↗