Psychiatric Quarterly, Vol. 76, No. 3, Fall 2005 (
DOES SYSTEM REFORM REDUCE
GEOGRAPHIC VARIATION IN MENTAL
HEALTH SYSTEM PERFORMANCE
Greg A. Greenberg, Ph.D. and Robert A. Rosenheck, MD
Substantial regional variation in health service use has been reported for both
general medical and mental health services. It is unknown however, whether
regional variation is reduced during periods of major system reform. Data from
the Department of Veterans Affairs’ are used to examine performance measures
for its 22 regional networks from 1996 to 2001, a period of major system reform.
Out of 21 mental health performance measures the coefﬁcient of variation (the
standard deviation divided by the mean) increased for 16 measures and declined
for only 5. Although regional variation increased only slightly on 12 of these 16
measures it appears system reform clearly does not reduce regional variation
across the board and it may in fact increase such variation for some aspects of
KEY WORDS: mental health; small area analysis; regional variation; Veterans Health
Administration; system change.
Greg A. Greenberg, Ph.D. is afﬁliated with Northeast Program Evaluation Center,
VAMC West Haven, Ct., Yale University Department of Psychiatry, New Haven, CT.
Robert A. Rosenheck, MD is afﬁliated with Northeast Program Evaluation Center,
VAMC West Haven, Ct., VA New England Mental Illness Research, Education, and Clin-
ical Center; Department of Psychiatry and Yale University School of Epidemiology and
Public Health, New Haven, CT.
Address correspondence to Greg Greenberg, Ph. D., Northeast Program Evaluation
Center, 950 Campbell Avenue, West Haven, CT 06516; e-mail: email@example.com.
2005 Springer Science+Business Media, Inc.