Service utilization and cost of community care for discharged state hospital patients: a 3-year follow-up study.
OBJECTIVE
This study examined the mental health service utilization and costs of 321 discharged state hospital patients during a 3-year follow-up period compared with costs if the patients had remained in the hospital.


METHODS
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 utilization and unit cost measures.


RESULTS
During the 3-year period after discharge, 20%-30% of the patients required rehospitalization an average of 76-91 days 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 over 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 had remained institutionalized.


CONCLUSIONS
This analysis suggests that most former long-stay patients are able to live in residential settings while receiving community outpatient treatment and intensive case management services at a reduced cost. There is no indication of cost shifting from the psychiatric to the health care sector; however, some cost shifting from the state mental health agency to the Medicaid program has occurred, since most psychiatric hospital care now takes place in community hospitals.
Rothbard
A B
AB
Center for Mental Health Policy and Services Research, Department of Psychiatry, Medical Center, Philadelphia, PA, USA. abr@cmhpsr.upenn.edu
Kuno
E
E
Schinnar
A P
AP
Hadley
T R
TR
Turk
R
R
D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000191:economics / Q000706:statistics & numerical data; D019090:Case Management / Q000191:economics; D003156:Community Mental Health Services / Q000191:economics* / Q000706:statistics & numerical data*; D003361:Cost Allocation; D003688:Deinstitutionalization / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs; D017721:Hospital Costs; D006760:Hospitalization / Q000191:economics* / Q000706:statistics & numerical data; D006764:Hospitals, Community / Q000191:economics / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006783:Hospitals, State / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D006278:Medicare / Q000191:economics; D001523:Mental Disorders / Q000191:economics / Q000628:therapy; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D012114:Residential Treatment / Q000191:economics; D014481:United States