DAY-HOSPITAL CRISIS-RESPITE-CARE VERSUS IN-PATIENT-CARE .2. SERVICE UTILIZATION AND COSTS

Objective: The authors compared service utilization and costs for acut ely ill psychiatric patients treated in a day hospital/crisis respite program or in a hospital inpatient program. Method: The patients (N=19 7) were randomly assigned to one of the two programs and followed for 10 months after discharge. Both programs were provided by a community mental health center (CMHC) in a poor urban community. Data were colle cted for developing service utilization profiles and estimates of per- unit costs of the inpatient, day hospital, and outpatient services pro vided by the CMHC. Results: On average, the day hospital/crisis respit e program cost less than inpatient hospitalization. The average saving per patient was $7,100, or roughly 20% of the total direct costs. The re were no significant differences between programs in service utiliza tion or cost during the follow-up phase. Cost savings accrued in the i ndex episode because per-unit costs were lower for day hospital/crisis respite and the average stay was shorter. Significant differences in cost were found among patient groups with psychosis, affective disorde rs, and dual diagnoses; psychotic patients had the highest costs in bo th programs. The two programs had roughly equal direct service staff a nd capital costs but significantly different operating costs (day hosp ital/crisis respite operating costs were 51% of inpatient hospital cos ts). Conclusions: The programs were equally effective, but day hospita l/crisis respite treatment was less expensive for some patients. Poten tial cost savings are higher for nonpsychotic patients. Cost differenc es between the programs are driven by the hospital's relatively higher overhead costs. The roughly equal expenditures for direct service sta ff costs in the two programs may be an important clue for understandin g why these programs provided equally effective acute care.