State psychiatric hospitals are an important provider of inpatient psychiatric services. However, with the increasing use of general hospitals for inpatient care, the questions about the interchangeability of state hospitals and general hospitals persists. Resolution of this question has important implications for allocating scarce mental health resources. There have been few studies exploring this issue in the era of managed care. The central questions in this study are: What is the relationship between utilization of psychiatric services in general hospitals and utilization of state hospitals? Further, in what ways does distance from the patient's home to the state hospital affect this relationship? State psychiatric hospital resources are concentrated to offer economies of scale. However, state hospitals located far from patients' homes may be less appealing and ultimately less accessible than local general hospitals to patients, families, and the clinicians who coordinate their care. If state/general hospital substitution is modified by distance, it may also affect state mental health authorities' plans about the location of state hospitals and the deployment of other mental health resources. We will address these issues through an analysis of 1998 North Carolina state hospital discharge records and 1998 North Carolina general hospital discharge records. We will determine, on a per capita basis, the substitutability of acute psychiatric hospitalization at state hospitals with acute psychiatric hospitalization at general hospitals. Further, we will determine if this substitutability is affected by the distance between state hospitals and patients' home counties.
Learning Objectives: At the end of the discussion, participants will understand: 1. The relationship between state and general hospital utilization; 2. The relationship between state hospital utilization and distance from home to hospital; 3. The relationship between state and general hospital utilization as modified by the distance from home to hospital
Keywords: Hospitals, Sever Mental Illness
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: North Carolina public mental health system
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Consultant to North Carolina Division of Mental Health