大规模心理健康改革的影响：来自巴西的证据
The Effects of a Large-Scale Mental Health Reform: Evidence from Brazil
American Economic Journal: Economic Policy · 2021 · [{"name": "Mateus Dias", "affiliation": ["Princeton University"]}, {"name": "Luiz Felipe Fontes", "affiliation": ["Abdul Latif Jameel Poverty Action Lab"]}]
中文摘要
本文研究了2002年巴西精神卫生改革，该改革通过引入心理社会照护中心（CAPS）作为住院治疗的社区型替代，重组了公共心理健康服务供给。我们的研究设计利用CAPS的推广，在双重差分框架下进行分析。我们发现，这些中心提高了门诊心理健康服务产出，并有效减少了因精神和行为障碍导致的住院。这些减少在长期住院患者和精神分裂症患者中更为明显。我们发现，住院减少所隐含的成本节约并不能完全抵消该政策的成本。此外，该改革对心理健康死亡率没有影响，但增加了暴力犯罪。
Abstract
This paper studies the 2002 Brazilian Psychiatric Reform, which reorganized the public mental healthcare provision by introducing Psychosocial Care Centers (CAPS) as a community-based substitute for inpatient care. Our research design exploits the roll-out of CAPS in a difference-in-differences framework. We show that these centers increased the outpatient mental healthcare production and were effective in reducing hospitalizations due to mental and behavioral disorders. These reductions were more pronounced for long-stay admissions and among patients with schizophrenia. We find that the implied savings from less admissions does not totally offset the cost of the policy. Also, the reform had no effects on mental health mortality, but increased violent crime.