Changing patterns of psychiatric inpatient care for children and adolescents in general hospitals, 1988-1995.
OBJECTIVE
The authors examine patterns in utilization of psychiatric inpatient services by children and adolescents in general hospitals during 1988-1995.


METHODS
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 study 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-days, from more than 3 million to about 2.5 million. The number of nonpsychotic major depressive disorders increased significantly. Discharges from public hospitals have declined, and those from proprietary hospitals have risen. Concurrently, the role of private insurance declined and the role of Medicaid increased. During the period of study, the mean and median length of stay declined most for children and adolescents who were hospitalized in private facilities and those covered by private insurance. Across the United States, the mean length of stay declined significantly; this decline was almost 60% in the West. Discharges also declined in the West, in contrast to the Midwest and the South, where they significantly increased.


CONCLUSIONS
Increased numbers of discharges and decreased length of stay may reflect evolving market forces and characteristics of hospitals. Further penetration by managed care into the public insurance system or modifications in existing Medicaid policy could have a profound impact on the availability of inpatient resources.
School of Social Work, Institute for Health, Health Care Policy and Aging Research, Rutgers University, New Brunswick, NJ 08901, USA. pottick@rci.rutgers.edu
K J
KJ
Pottick
D D
DD
McAlpine
R B
RB
Andelman
D000293:Adolescent; D000367:Age Factors; D002648:Child; D003953:Diagnosis-Related Groups; D004469:Economics, Hospital; D006742:Hospital Bed Capacity; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006777:Hospitals, Proprietary / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006788:Hospitals, Voluntary / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000175:diagnosis / Q000191:economics / Q000453:epidemiology*; D010351:Patient Discharge / Q000706:statistics & numerical data; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014600:Utilization Review