Administrative influences on psychiatric diagnosis

Summary

In order to cut expenditure on mental health care in Brazil, the national authority responsible for the financing of health care imposed in 1977 the following two restrictions on reimbursement: a) the costs for inpatient treatment under the diagnoses “neurosis” and “alcoholism” would be paid only for a maximum length of hospital stay of 30 days and b) the costs for inpatient treatment under the diagnoses “oligophrenias” and “epilepsies” would no longer be paid. We studied the effects of these administrative measures upon the yearly frequencies of diagnoses and the mean lengths of hospital stay in 27377 treatment episodes between 1975 and 1982. We found significant decreases in both variables for the above mentioned diagnoses after 1977. At the same time the frequencies of the diagnoses “alcoholic psychoses”, “psychoses associated with other cerebral conditions” and “other psychoses” increased significantly. These findings can probably not be attributed to true changes in morbidity, but are rather the results of changes in diagnostic habits in response to administratively imposed austerity measures.