Am J Psychiatry 1996; 153:1613-1619
Copyright © 1996 by American Psychiatric Association
Mental disorders in public, private nonprofit, and proprietary general hospitals
M Olfson and D Mechanic
Department of Psychiatry, College of Physicians and Surgeons of Columbia University/New York State Psychiatric Institute, NY 10032, USA.
OBJECTIVE: The authors' goal was to assess the effects of facility
ownership on the characteristics of psychiatric inpatients treated in
public, private nonprofit, or proprietary general hospitals. METHOD: Data
from the 1993 National Hospital Discharge Survey were analyzed to determine
the number, sociodemographic and diagnostic composition, and treatment
characteristics of patients with primary mental disorders discharged from
public, private nonprofit, and proprietary general hospitals. RESULTS: An
estimated 1.83 million patients with a primary mental disorder diagnosis
were discharged from general hospitals in 1993; the number of such
discharges in the National Hospital Discharge Survey, which excluded
federal general hospitals, was 13,086. These patients were unevenly
distributed among public (9.4%), private nonprofit (78.9%), and proprietary
(11.7%) hospitals. Psychiatric patients of public and private nonprofit
hospitals were more likely to be diagnosed with schizophrenia (public:
23.4%, nonprofit: 18.8%, proprietary: 12.6%), a comorbid substance-related
disorder (public: 29.9%, nonprofit: 31.0%, proprietary: 17.4%), a
personality disorder (public: 11.6%, nonprofit: 11.3%, proprietary: 4.7%),
or a general medical disorder (public: 62.4%, nonprofit: 57.4%,
proprietary: 41.1%) than patients of proprietary hospitals. Uninsured
psychiatric patients were far more common at public hospitals than at the
other types of facilities (public: 17.0%, nonprofit: 9.9%, proprietary:
6.4%). CONCLUSIONS: Public general hospitals play an important role in
caring for uninsured patients with severe mental illness. Before widespread
closures occur in the public general hospital sector, it is critical that
policy makers identify and develop resources to replace the care these
institutions currently provide to poor patients with severe psychiatric
disorders.
