Am J Psychiatry 1996; 153:1074-1083
Copyright © 1996 by American Psychiatric Association
Day hospital/crisis respite care versus inpatient care, Part II: Service utilization and costs
WH Sledge, J Tebes, N Wolff and TW Helminiak
Department of Psychiatry, Yale University School of Medicine, New Haven, CT 06519, USA.
OBJECTIVE: The authors compared service utilization and costs for acutely
ill psychiatric patients treated in a day hospital/crisis respite program
or in a hospital inpatient program. METHOD: The patients (N = 197) were
randomly assigned to one of the two programs and followed for 10 months
after discharge. Both programs were provided by a community mental health
center (CMHC) in a poor urban community. Data were collected for developing
service utilization profiles and estimates of per-unit costs of the
inpatient, day hospital, and outpatient services provided by the CMHC.
RESULTS: On average, the day hospital/crisis respite program cost less than
inpatient hospitalization. The average saving per patient was +7,100, or
roughly 20% of the total direct costs. There were no significant
differences between programs in service utilization or costs during the
follow-up phase. Cost savings accrued in the index episode because per-unit
costs were lower for day hospital/crisis respite and the average stay was
shorter. Significant differences in cost were found among patient groups
with psychosis, affective disorders, and dual diagnoses; psychotic patients
had the highest costs in both programs. The two programs had roughly equal
direct service staff and capital costs but significantly different
operating costs (day hospital/crisis respite operating costs were 51% of
inpatient hospital costs). CONCLUSIONS: The programs were equally
effective, but day hospital/crisis respite treatment was less expensive for
some patients. Potential cost savings are higher for nonpsychotic patients.
Cost differences between the programs are driven by the hospital's
relatively higher overhead costs. The roughly equal expenditures for direct
service staff costs in the two programs may be an important clue for
understanding why these programs provided equally effective acute care.
