Ab. Rothbard et al., Service utilization and cost of community care for discharged state hospital patients: A 3-year follow-up study, AM J PSYCHI, 156(6), 1999, pp. 920-927
Objective: This study examined the mental health service utilization and co
sts of 321 discharged state hospital patients during a 3-year follow-up per
iod compared with costs if the patients had remained in the hospital. Metho
d: The study subjects were long-stay patients discharged from Philadelphia
State Hospital after 1988. A longitudinal integrated database on all mental
health and medical services reimbursed by Medicaid and Medicare as well as
state- and county-funded services was used to construct service utilizatio
n and unit cost measures. Results: During the 3-year period after discharge
, 20%-30% of the patients required rehospitalization an average of 76-91 da
ys per year. The percentage of rehospitalized patients decreased over time,
but the number of hospital days increased. All of the discharged patients
received case management services, and a majority also received outpatient
mental health care (66%-70%) and residential services (75%) throughout the
follow-up period. The total treatment cost per person was approximately $60
,000 a year after controlling for inflation, with costs rising slightly ove
r the 3-year period. The estimated cost of state hospitalization, with the
use of 1992 estimates, would have been $130,000 per year if the patients ha
d remained institutionalized. Conclusions: This analysis suggests that most
former long-stay patients are able to live in residential settings while r
eceiving community outpatient treatment and intensive case management servi
ces at a reduced cost. There is no indication of cost shifting from the psy
chiatric to the health care sector; however, some cost shifting from the st
ate mental health agency to the Medicaid program has occurred, since most p
sychiatric hospital care now takes place in community hospitals.