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Characteristics of High Utilizers Under Managed Care

In many states, the adoption of managed care principles has accelerated already declining hospital use by mentally ill patients as a result of deinstitutionalization. This report identified characteristics of frequent users of inpatient psychiatric services under public-sector managed care in Massachusetts from 1992 to 1995.

Compared with the other inpatients, high utilizers (those with five or more admissions per year) were more likely to be young Caucasian females with personality disorder and a history of substance abuse (but not current substance abuse disorder). They also had lower functioning and higher levels of distress than the other inpatients. Although only 6% to 8% of patients were high utilizers, they accounted for 21% to 27% of all admissions. Most importantly, high utilizers had significantly longer hospitalizations when they were admitted to many different hospitals.

Comment: This study identifies a paradoxical managed care outcome: longer hospital stays following increased "management" of care. However, this result is not due to managing care per se, but rather to the method of management used (i.e., one that employed a large consortium of hospitals). The discontinuity of treatment sites and adverse effects on a patient population who are most in need of management suggest that states should provide a single site of hospitalization. Specialized programs for patients with borderline personality who are high utilizers will be important in order to achieve better control of hospital use.

— P Roy-Byrne

Published in Journal Watch Psychiatry June 1, 1998

Citation(s):

Geller JL et al. The effects of public managed care on patterns of intensive use of inpatient psychiatric services. Psychiatr Serv 1998 Mar 49 327-332.

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