Does System Reform Reduce Geographic Variation in Mental Health System Performance

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 care.