Hospital Length of Stay for Schizophrenia: Is Primary Payer an Influencing Factor?
David A. Sclar
Linda M. Robison
Tracy L. Skaer
Richard S. Galin
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.
In order to set up a list of libraries that you have access to,
you must first login
or sign up.
Then set up a personal list of libraries from your profile page by
clicking on your user name at the top right of any screen.