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Aims: This research examined factors related to the average length of hospital stay (LOS) and average direct medical costs (DMC) for 2291 psychogeriatric inpatients (aged 65 and over) admitted for the first time to a psychiatric ward in 2002.
Methods: Hospitalization claim data of these inpatients were traced for the subsequent 6 years (2002–2007) from the dataset of Taiwan's National Health Insurance program. Analysis was carried out using the t-test, χ2-test and zero truncated Tobit regression.
Results: Mean LOS and mean DMC were significantly different according to sex, psychiatric diagnosis, institution type, ownership type, and number of hospitalizations, but age was the exception. Both LOS and DMC exhibited downward U-shape for the number of hospitalizations. Factors significantly associated with longer LOS and higher DMC were: male sex; schizophrenic and delusional disorders (compared with dementia); and public institution (compared with private hospital). Compared with dementia, organic mental and anxiety disorders had significantly shorter LOS, and affective disorders had shorter LOS but higher DMC. Community and psychiatric hospitals (compared with general hospital) significantly influenced LOS but not DMC.
Conclusion: Our results can be used as a reference for providers and policymakers to improve psychiatric care efficiency and carry out National Health Insurance financial reform for psychogeriatric inpatients.
THE ISSUES OF determination of length of hospital stay (LOS) and direct medical costs (DMC) play an important role in evaluating the healthcare efficiency and quality, as well as hospital resource utilization, for psychiatric care.1,2 Compared with other diseases, the LOS and DMC of mental illness for the geriatric population are more important and complex because of their characteristics of chronicity, greater levels of functional disability, and cognitive and social functioning impairments.3 Due to the continuous and dramatic rise in the percentage of aged persons (≥65 years old) in the total population, from 4.1% in 1980 to 10.7% in 2010, in Taiwan, increasing numbers of psychogeriatric inpatients are in need of care.4,5 Therefore, exploring the factors that influence the LOS and DMC for psychogeriatric care is important for reducing the costs associated with care of geropsychiatric patients in the National Health Insurance (NHI) system.
In the previous reports, factors affecting psychiatric patient LOS among mixed age populations are associated with institutional characteristics,6–8 health-care system,9,10 demographic factors,11,12 and psychiatrists' caseload.13 However, very few studies focus on the factors for geriatric population LOS.3,8,14
In addition, prior studies discussing the factors related to psychogeriatric inpatient DMC are limited to one specific mental illness, such as Alzheimer's disease,1,2,15,16 affective disorder,17,18 schizophrenic disorder,19,20 anxiety disorder,21–23 or comparison of the costs among different mental disorders.24 Few studies analyze the factors influencing psychogeriatric inpatient DMC using broader variables which include comparisons among various mental disorders, demographic factors, and institutional characteristics. We thus attempt to fill this gap by capturing the complexities of factors affecting psychogeriatric inpatient DMC and LOS.
Using a dynamic national dataset of psychogeriatric inpatients in 2002 and the subsequent 6 years (2002–2007) from Taiwan's NHI program, this study had three aims: to analyze the relation of institution type and type of psychiatric diagnosis to LOS (or DMC); to examine the characteristics of psychogeriatric inpatients and types of health facility that affect the LOS (or DMC); and to explore the relation between LOS (or DMC) and the number of hospitalizations. The empirical findings obtained from this study can be used as a reference for providers and policymakers to improve psychiatric care efficiency and carry out NHI financial reform for psychogeriatric inpatients.