Service utilization and cost of community care for discharged state hospital patients: A 3-year follow-up study

Citation
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
Citations number
38
Categorie Soggetti
Psychiatry,"Clinical Psycology & Psychiatry","Neurosciences & Behavoir
Journal title
AMERICAN JOURNAL OF PSYCHIATRY
ISSN journal
0002953X → ACNP
Volume
156
Issue
6
Year of publication
1999
Pages
920 - 927
Database
ISI
SICI code
0002-953X(199906)156:6<920:SUACOC>2.0.ZU;2-P
Abstract
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.