ding ( Frank and Goldman, 1989), and other reimbursement possibilities
raise new quandaries about how government might devise incentives for
private providers to fulfill public mental health policy objectives regard-
ing the content, volume, quality, and locations of care. This development
reflects the larger trend of health care finance, but the objectives of public
administrators often deviate importantly between the mental health and
health care systems. For example, underutilization of needed services is
much more of a concern for the mentally ill ( Frisman and McGuire,
1989). The New York State Office of Mental Health has launched an
ambitious experiment to restructure psychiatric treatment for the seri-
ously mentally ill by means of an innovative payment formula for gen-
eral hospital psychiatric units that rewards increased access to care,
inpatient-outpatient linkages, and appropriate lengths of stay ( Boyer and
Mechanic, 1992). A direct extension of policy currents of the past decade,
the intent of this project is on sound footing from a political-economy
perspective, and its operation should shed light on mental health reform
via a reimbursement strategy.

Politics has been called the most popular of all spectator sports. Much
more than that, however, it is the political process in society that deter-
mines what resources will be allocated to an area such as mental health
services and, in large measure, how these services will be organized and
whether they will achieve their intended effects. Though it may be, as
Dorothea Dix had occasion to observe, that participation in the political
arena is not always a gratifying experience, there can be no other option
for effective advocacy within our democratic system--and this, her
lengthy public career tells us, Dix also knew. Murray Levine, author of
The History and Politics of Community Mental Health ( 1981: 9), succinctly
makes the point when stating that "politics is not wrong or bad. It is
inevitable. It is bad or wrong only if we blind ourselves to those inevi-
tabilities."

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