OBJECTIVE: There is little current understanding of how managed care
strategies affect hospital inpatient psychiatric care for mentally ill
patients. This study examined one prominent form of managed care,
utilization management, which reviews requests for psychiatric care and
authorizes provision of care deemed appropriate and clinically necessary.
METHOD: The authors analyzed data on 2,265 utilization management reviews
conducted during 1989-1992 for patients insured by a single large
commercial insurance company. Three utilization management procedures were
examined: preadmission review, continued-stay review, and case management.
The performance indicators analyzed included percent of admission requests
granted, number of days requested and approved, and number of treatment
extensions granted. RESULTS: Utilization management initially approved
inpatient psychiatric treatment for nearly all (98.8%) of the patients but
authorized, on average, only one-third of the days requested (6.9 versus
19.0). On average, 23.5 (total) days of care were requested and 16.8 days
were approved. Care for patients with alcohol or drug dependence diagnoses
was more restricted than was care for other patients. CONCLUSIONS: These
data suggest that managed care does restrict inpatient psychiatric care,
primarily by managing length of stay. The fact that almost all patients
were approved for the same initial length of stay implies adherence to
strict treatment protocols that do not distinguish among different clinical
or patient factors. There is a need for careful study of the effects of
managed care on outcomes and quality of psychiatric care.