Psychiatric patients frequently are transferred from acute-care and specialty hospitals to community-funded facilities for economic reasons, a problem that hasn't been alleviated by federal laws against patient dumping, according to a new study.
The study relies on interviews from 1988 and 1989, but its authors said the problem most likely has worsened because of economic factors that continue to make psychiatric patients less attractive as inpatient cases.
The study appears in the December issue of Health Services Research, a journal of the American Hospital Association's Hospital Research and Educational Trust. It was conducted by researchers at Yale University School of Medicine and the Kennedy School of Government at Harvard University.
The primary source of data is a nearly decade-old survey of 640 community mental health centers. Along with state psychiatric hospitals, community centers, which are publicly funded, often end up caring for patients released from other facilities.
Because of the data's limits, the results of the study are approximations at best, the researchers said.
The study found:
Roughly two-thirds of hospitals offering inpatient psychiatric care routinely transferred psychiatric patients to other facilities because of insurance limits or other economic reasons.
One-fourth of the community mental health centers believed a "great deal" of dumping took place in their regions; but 15% indicated little occurred.
In markets with public, for-profit and not-for-profit providers, three-fourths of respondents said they believed for-profit hospitals were most likely to transfer psychiatric patients for economic reasons. One-fifth said not-for-profits were most likely.
National surveys of hospitals and psychiatrists, also taken during 1988 and 1989, were used to verify the conclusions.
Mark Schlesinger, the study's lead author, said although results must be treated cautiously, they indicate the failure of federal laws to fully address the problem of economically motivated patient transfers. A 1986 law bars hospitals from transferring medically unstable emergency patients or women in labor to other facilities for economic reasons, a practice known as patient dumping.
"But all of these safeguards of the 1980s did nothing to prevent transfer of psychiatric patients," said Schlesinger, an associate professor of public health at Yale's medical school.
The problem most likely has worsened, he said, because "you have more for-profit hospital companies on the scene, hospitals becoming more competitive and managed care coming along limiting hospital stays."
The National Association of Psychiatric Health Systems said that managed-care plans and other payers should be held accountable for the burden placed on public health by such patient transfers.
"The public healthcare system has evolved as a safety net because of discriminatory mental health benefits," said Mark Covall, executive director of the Washington-based NAPHS, which represents about 300 psychiatric hospitals. "This is a system issue, not an issue related to hospital care or to hospitals' financial interests."