Determinants of health plan membership among patients in routine U.S. psychiatric practice

Extended duration of hospitalization in first episode psychosis: an evaluation of its clinical justification

Short periods of hospitalization for first episode psychosis are generally considered preferable, although research evidence is inconsistent. Clinical and social determinants of length of hospital stay (LOS) were examined in 121 admissions for first episode psychosis using standardized assessment measures, in five clinical units of a French psychiatric hospital. LOS varied from 4 to 371 days, and considerably between units. LOS was examined both as a continuous variable and dichotomized comparing short (<31 days) to long (>31 days) stays. In the multivariate analyses, change in antipsychotic medication and the unit head psychiatrist's preference for longer stays were significantly associated with both measures of LOS, indicating effects on LOS per SE and not only with respect to a threshold duration of stay. Of the clinical factors at admission, the only borderline significant association found was between the severity of negative symptoms and LOS on a continuum. Despite some justification for longer stays with respect to discharge conditions, the persisting association with the head psychiatrist's preference for long or short stays strongly suggests a need for greater evidence-based rationalization of practice.

Health insurance coverage among persons with schizophrenia in the United States

OBJECTIVE

This study estimated the rates of health insurance coverage in the U.S. civilian noninstitutionalized population with schizophrenia and assessed whether basic access to health care varied across health insurance categories.

METHODS

Data from the Medical Expenditures Panel Survey collected between 2002 and 2006 were used.

RESULTS

The sample contained 328 records representing 493,006 noninstitutionalized civilian persons with schizophrenia. Eighty-seven percent had Medicaid or Medicare, 8% received care through the Veterans Health Administration, and 15% had private insurance for at least one day during the year. About 7% were uninsured all of the year. The uninsured tended to be male (92%), nonwhite (54%), and unmarried (97%), and 30% of the uninsured had not had a medical checkup in more than five years.

CONCLUSIONS

Almost all U.S. adults with schizophrenia were found to receive government health insurance, yet a measurable minority remained uninsured. These national estimates highlight opportunities for improving health service delivery for this vulnerable population.