Skip to main content
SpringerLink
Log in

Hospital Length of Stay for Schizophrenia

Is Primary Payer an Influencing Factor?

  • Original Research Article
  • Published:
Disease Management and Health Outcomes

Abstract

Objective: The purpose of this study was 3-fold: (i) to determine the distribution of US patients diagnosed with schizophrenia and requiring a hospitalisation in the calendar year 1988 or 1992, by primary payer type (Medicare; Medicaid; or private insurance); (ii) to discern the mean inpatient length of stay and charge per day in 1988 or 1992, by payer type; and (iii) to test for time trends between 1988 and 1992, for inpatient hospital length of stay and charge per day.

Design and setting: A retrospective study using the Healthcare Cost and Utilisation Project (HCUP-3) Nationwide Inpatient Sample (NIS), Release 1, as the database.

Patients and participants: The study population was selected from all 1988 and 1992 discharges of patients that were >10 years of age; had an International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic code of 295.00 to 295.95, indicating schizophrenia as the primary diagnosis; were hospitalised between 1 and 40 days; and had Medicare, Medicaid, or private insurance, inclusive of fee-for-service or managed care, identified as the primary source of insurance coverage. The final sample used for this analysis consisted of 22 479 discharges from 1988, and 33 969 discharges from 1992.

Main outcome measures and results: After adjusting for potentially confounding factors, the mean hospital length of stay for schizophrenia decreased by over 1 day (from 10.1 to 9.0; p < 0.0001) between 1988 and 1992 among individuals covered by private insurance; whereas the mean hospital length of stay for both Medicare and Medicaid beneficiaries remained unchanged. These findings existed in the presence of a uniform inflationary increase in mean hospital charges per day by payer category.

Conclusions: Further research is required to determine whether the observed downward trend in hospital length of stay was a result of private payers enhancing patient care and thereby discharging patients in a more efficient manner, or if patients were discharged prematurely because of financial incentives operating within private insurance programmes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. American Psychiatric Association. Practice guideline for the treatment of patients with schizophrenia. Am J Psychiatry 1997; 154 Suppl.: 1–63

    Google Scholar 

  2. Mortensen PB. Schizophrenia in society: an epidemiological perspective. Dis Manage Health Outcomes 1997; 2: 77–84

    Article  Google Scholar 

  3. Miller DD. Schizophrenia: its etiology and impact. Pharmacotherapy 1996; 16(1 Pt 2): 2–5

    PubMed  CAS  Google Scholar 

  4. Hafner H, van der Heiden W. Epidemiology of schizophrenia. Can J Psychiatry 1997; 42: 139–51

    PubMed  CAS  Google Scholar 

  5. Nordquist GS, Regier DA, Rupp A. Estimates of the cost of treating people with schizophrenia: contributions of data from epidemiologic surveys. In: Moscarelli M, Rupp A, Sartorius N, et al., editors. Handbook of mental health economics and health policy. Vol. 1. Schizophrenia. New York: John Wiley & Sons, 1996

    Google Scholar 

  6. Terkelsen KG, Menikoff A. Measuring the costs of schizophrenia: implications for the post-institutional era in the US. Pharmacoeconomics 1995; 8: 199–222

    Article  PubMed  CAS  Google Scholar 

  7. Wasylenki DA. The cost of schizophrenia. Can J Psychiatry 1994; 39(9 Suppl. 2): S65–S69

    PubMed  CAS  Google Scholar 

  8. Rupp A, Keith S. The costs of schizophrenia: assessing the burden. Psychiatr Clin North Am 1993; 16: 413–23

    PubMed  CAS  Google Scholar 

  9. Sharfstein SS. Prospective cost allocations for the chronic schizophrenic patient. Schizophr Bull 1991; 17: 395–400

    PubMed  CAS  Google Scholar 

  10. Williams R, Dickson RA. Economics of schizophrenia. Can J Psychiatry 1995; 40(7 Suppl. 2): S60–S67

    PubMed  CAS  Google Scholar 

  11. Ryan PM. Epidemiology, etiology, diagnosis, and treatment of schizophrenia. Am J Hosp Pharm 1991; 48: 1271–80

    PubMed  CAS  Google Scholar 

  12. Lehman AF. Managing schizophrenia: interventions and outcomes. Dis Manage Health Outcomes 1997; 1: 286–95

    Article  Google Scholar 

  13. Eaton WW, Mortensen PB, Herrman H, et al. Long-term course of hospitalization for schizophrenia: part I. Risk for rehospitalization. Schizophr Bull 1992; 18: 217–28

    PubMed  CAS  Google Scholar 

  14. Knapp M, Kavanagh S. Economic outcomes and costs in the treatment of schizophrenia. Clin Ther 1997; 19: 128–38

    Article  PubMed  CAS  Google Scholar 

  15. Addington DE, Jones B, Bloom D, et al. Reduction of hospital days in chronic schizophrenic patients treated with risperidone: a retrospective study. Clin Ther 1993; 15: 917–26

    PubMed  CAS  Google Scholar 

  16. Wickizer TM, Lessler D. Do treatment restrictions imposed by utilization management increase the likelihood of readmission for psychiatric patients? Med Care 1998; 36(6): 844–50

    Article  PubMed  CAS  Google Scholar 

  17. Thorpe KE. The health system in transition: care, cost and coverage. J Health Polit Policy Law 1997; 22: 339–61

    PubMed  CAS  Google Scholar 

  18. Oberlander JB. Managed care and Medicare reform. J Health Polit Policy Law 1997; 22: 595–631

    PubMed  CAS  Google Scholar 

  19. Freund DA, Hurley RD. Medicaid managed care: contribution to issues of health reform. Ann Rev Pub Health 1995; 16: 473–95

    Article  CAS  Google Scholar 

  20. Dickey B, Normand S-LT, Norton EC, et al. Managing the care of schizophrenia: lessons from a 4-year Massachusetts Medicaid study. Arch Gen Psychiatry 1996; 53: 945–52

    Article  PubMed  CAS  Google Scholar 

  21. Dorwart RA. Managed mental health care: myths and realities in the 1990s. Hosp Community Psychiatry 1990; 41: 1087–91

    PubMed  CAS  Google Scholar 

  22. Appleby L, Desai PN, Luchins DJ, et al. Length of stay and recidivism in schizophrenia: a study of public psychiatric hospital patients. Am J Psychiatry 1993; 150: 72–6

    PubMed  CAS  Google Scholar 

  23. Agency for Health Care Policy and Research. Documentation for The HCUP-3 Nationwide Inpatient Sample (NIS), Release 1, 1988–1992. Springfield (VA): National Technical Information Service, 1992

    Google Scholar 

  24. US Public Health Service and Health Care Financing Administration. The international classification of diseases. 9th rev. Clinical modification. Vol. 2. Washington: Public Health Service, 1989. DHHS Pub. No. (PHS) 89-1260

    Google Scholar 

  25. American Hospital Association. 1988 Annual Survey of Hospitals. In: Hospital statistics. Chicago: American Hospital Association, 1989: 234–56

    Google Scholar 

  26. American Hospital Association. 1992 Annual Survey of Hospitals. Hospital statistics. Chicago: American Hospital Association, 1993: 242–69

    Google Scholar 

  27. Harris DR, Ball JK. Hospital resource use by HIV-infected females. Provider Studies Research Note 25, Agency for Health Care Policy and Research, Rockville (MD): Public Health Service, 1995. AHCPR Pub. No. 96-N001

    Google Scholar 

  28. Social Security Administration. Disability. Rockville (MD): Social Security Administration, 1995 Apr. SSA Publication No. 05-10029, ICN 45600

  29. Ginzberg E, Ostow M. Managed care — a look back and a look ahead. N Engl J Med 1997; 336: 1018–20

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Pharmacoeconomics and Pharmacoepidemiology Research Unit, College of Pharmacy, Washington State University, PO Box 646510, Pullman, Washington, 99164-6510, USA

    David A. Sclar B.Pharm., Ph.D. (Professor of Health Policy and Administration, Boehringer Ingelheim Scholar in Pharmaceutical Economics, Director), Linda M. Robison MSPH (Research Coordinator) & Tracy L. Skaer B.Pharm., Pharm.D. (Associate Professor of Pharmacy Practice, Assistant Dean, Clinical Pharmacist and Director)

  2. Program in Statistics, Washington State University, Pullman, Washington, USA

    David A. Sclar B.Pharm., Ph.D. (Professor of Health Policy and Administration, Boehringer Ingelheim Scholar in Pharmaceutical Economics, Director)

  3. Eastern Branch, Washington Institute for Mental Illness Research & Training, Spokane, Washington, USA

    David A. Sclar B.Pharm., Ph.D. (Professor of Health Policy and Administration, Boehringer Ingelheim Scholar in Pharmaceutical Economics, Director)

  4. Pullman Memorial Hospital, Pullman, Washington, USA

    Tracy L. Skaer B.Pharm., Pharm.D. (Associate Professor of Pharmacy Practice, Assistant Dean, Clinical Pharmacist and Director) & Richard S. Galin M.D. (Research Psychiatrist)

  5. Neuro-Psychiatric Institute, University of California at Los Angeles, Los Angeles, California, USA

    Richard S. Galin M.D. (Research Psychiatrist)

Authors
  1. David A. Sclar B.Pharm., Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Linda M. Robison MSPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tracy L. Skaer B.Pharm., Pharm.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Richard S. Galin M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David A. Sclar B.Pharm., Ph.D..

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sclar, D.A., Robison, L.M., Skaer, T.L. et al. Hospital Length of Stay for Schizophrenia. Dis-Manage-Health-Outcomes 5, 339–347 (1999). https://doi.org/10.2165/00115677-199905060-00004

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-199905060-00004

Keywords

Search

Navigation