title: Cost variation in child and adolescent psychiatric inpatient treatment.
abstract: Publicly available costs data for child and adolescent psychiatric inpatient services do not allow links to be made with patients' needs and outcomes. Without this information commissioners may reduce the role of inpatient services on the basis of budgetary impacts alone. This study estimates the support costs before, during and after an inpatient admission and explores the associations between costs, needs and outcomes. A detailed prospective cohort study of eight child and adolescent units was undertaken in which participants were assessed at referral, admission, decision to discharge and 1 year later. Mean admission costs were pound24,120, although the range was wide. Associations were found between costs and patients' global impairment, age and exclusion status. Support costs after admission were similar to pre-admission costs, but there was some evidence to suggest that services were better targeted. Moves in England to develop national tariffs for inpatient psychiatric episodes should be based on the likely cost of the episode of treatment rather than costs per day, and good commissioning requires more information on the predictors of such costs.
authors.affiliation: PSSRU, University of Kent, Kent, UK. J.K.Beecham@kent.ac.uk
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Beecham
authors.forename: Jonathan
authors.initials: J
authors.lastname: Green
authors.forename: Brian
authors.initials: B
authors.lastname: Jacobs
authors.forename: Graham
authors.initials: G
authors.lastname: Dunn
mesh_terms: D000293:Adolescent; D002017:Budgets; D002648:Child; D002675:Child, Preschool; D004739:England; D017050:Episode of Care; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics*; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D001523:Mental Disorders / Q000191:economics* / Q000628:therapy*; D020380:Needs Assessment / Q000191:economics / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010343:Patient Admission / Q000191:economics; D005791:Patient Care / Q000191:economics; D010359:Patient Readmission / Q000191:economics / Q000706:statistics & numerical data; D011567:Psychiatric Department, Hospital / Q000191:economics*