CONTROLLING INPATIENT PSYCHIATRIC UTILIZATION THROUGH MANAGED CARE

Objective: There is little current understanding of how managed care s trategies affect hospital inpatient psychiatric care for mentally ill patients. This study examined one prominent form of managed care, util ization management, which reviews requests for psychiatric care and au thorizes provision of cave deemed appropriate and clinically necessary . Method: The authors analyzed data on 2,265 utilization management re views conducted during 1989-1992 for patients insured by a single larg e commercial insurance company. Three utilization management procedure es were examined: preadmission review, continued-stay review, and cas e management. The performance indicators analyzed included eel cent of admission requests granted number of days requested and approved, and number of treatment extensions granted. Results: Utilization manageme nt initially approved inpatient psychiatric treatment for nearly all ( 98.8%) of the patients but authorized on average, only one-third of th e days requested (6.9 versus 19.0). On average, 23.5 (total) days of c are were requested and 16.8 days were approved. Care for patients with alcohol or drug dependence diagnoses was more restricted than was cav e for other patients. Conclusions: These data suggest that managed car e does restrict inpatient psychiatric care, primarily by managing leng th of stay. The fact that almost all patients were approved for the sa me initial length of stay implies adherence to strict treatment protoc ols that do not distinguish among different clinical or patient factor s. There is a need for careful study of the effects of managed care on outcomes and quality of psychiatric care.