Hospital Payment Effects on Acute Inpatient Care for Mental Disorders

We examined the extent to which inpatient care for patients with mental disorders in general, acute care hospitals responds differently to two types of prospective hospital payment. In Maryland, hospitals have been regulated since 1976 under two forms of payment based on per-service and per-case definitions of hospital output. The study utilizes a 20% sample of 58,000 mental-disorder discharges from 21 percase— and 24 per-service—reimbursed hospitals in Maryland between fiscal years 1977 and 1980. The effects of payment method on length of stay are examined through the application of multivariate regression models. The empirical results are generally consistent with the notion that the per-case payment method provides some incentives for hospitals to reduce the length of stay. The regulatory effects, however, vary with patient characteristics, particularly by diagnosis.