Objective: To examine whether vulnerable patients with mental illnesses,including the poor, the uninsured, and those with more complex illnesses,are at increased risk for being transferred from general hospitals. Methods: Data come from discharge records for approximately 250,000 inpatientpsychiatric stays from the 1996 Healthcare Cost and Utilization Project, a nationwide sample of discharges from general hospitals. Competing risks Cox survival models were used to estimate the effects of insurance, facility type, diagnosis and other predictors of length of stay on the relative chances of discharge to the community versus transfer to other facilities. Results: Preliminary analysis reveals that type of insurance was one of the most important predictors of timing of discharge. Furthermore, persons admitted to for-profit facilities were about twice as likely to be transferred as those admitted to non-profit facilities. Patients with more severe mental illness or comorbidity were also more likely to be transferred. Conclusions: The observation that patients in proprietary hospitals and those with more complex illnesses are at risk for being transferred suggests that patients may be being 'dumped' for economic reasons. Continuing deinstitutionalization, increased privatization and competition, and managed care all provide incentives for hospitals to transfer unprofitable patients. Such practices are likely to interrupt continuity of services, undermine quality of care, and increase anxiety and uncertainty for patients and their families. Moreover, the practice of transferring more costly patients may threaten the viability of the public system.
Learning Objectives: 1)Identify the factors that increase risk of transfer from a general hospital for persons with mental illness; 2) Understand the application of survival models in general, and competing risks models in particular, to issues in health services research
Keywords: Mental Health Services, Health Insurance
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.