Changing patterns of psychiatric inpatient care for children and adolescents in general hospitals, 1988-1995

Objective: The authors examine patterns in utilization of psychiatric inpat ient services by children and adolescents in general hospitals during 1988- 1995. Method: National Hospital Discharge Survey data were used to describe utilization patterns for children and adolescents with primary psychiatric diagnoses in general hospitals from 1988 to 1995. Results: During the stud y period, there was a 36% increase in hospital discharges and a 44% decline in mean length of stay, resulting in a 23% decline in the number of bed-da ys, from more than 3 million to about 2.5 million. The number of nonpsychot ic major depressive disorders increased significantly. Discharges from publ ic hospitals have declined, and those from proprietary hospitals have risen . Concurrently, the role of private insurance declined and the role of Medi caid increased. During the period of study, the mean and median length of s tay declined most for children and adolescents who were hospitalized in pri vate facilities and those covered by private insurance. Across the United S tates, the mean length of stay declined significantly; this decline was alm ost 60% in the West. Discharges also declined in the West, in contrast to t he Midwest and the South, where they significantly increased. Conclusions: Increased numbers of discharges and decreased length of stay may reflect ev olving market forces and characteristics of hospitals. Further penetration by managed care into the public insurance system or modifications in existi ng Medicaid policy could have a profound impact on the availability of inpa tient resources.