New data from AHRQ highlight inpatient hospitalizations for mental health and substance abuse disorders, including costs, length of stay, and payor mix. Overall, the AHRQ statistics show interesting differences between inpatient stays for mental health, substance abuse, and all other conditions, as well as significant utilization and cost differences among states.
Community Hospitals: While treatment may occur in specialized psychiatric or chemical dependency hospitals, community hospitals provide the majority of hospital-based care for mental health and substance abuse disorders, typically in specialty units of general medical-surgical hospital facilities:
- Over 50% of hospital spending for mental health (MH) treatment.
- Over of 75% of hospital spending for substance abuse (SA) treatment took place in inpatient or outpatient departments of community hospitals.
Common Diagnoses: The mental health-substance abuse (MHSA) conditions most frequently treated in community hospitals are:
- Mood disorders (depression and bipolar disorder).
- Schizophrenia and other psychotic disorders.
- Alcohol-related disorders and drug-related disorders, most often for substance withdrawal.
Overall Utilization and Spending: In the U.S., mental health (MH) and substance abuse (SA) disorders account for 4.5% of all hospitalizations (about 1.8 million inpatient admissions in community hospitals). MHSA hospital stays cost $9.7 billion in 2008 or 2.7 percent of all inpatient community hospital costs.
Average Cost for Hospital Stay: MH and SA hospitalizations are, on average, less expensive than non-MHSA stays:
- $5,700 per MH stay.
- $4,600 per SA stay.
- $9,300 per stay for all other conditions.
Wide Variation by State: The average cost of inpatient hospital stays for mental health or substance abuse disorders vary widely from state to state. The average cost of a MH stay in the highest cost state ($13,300) was four times that in the lowest cost state ($2,900). For SA stays, the average cost in the highest cost state ($6,600) was more than twice that in the lowest cost state ($2,900).
MHSA Length of Stay: Hospital lengths of stay for mental health or substance abuse disorders also vary considerably, especially for mental health-related admissions. Nationwide, the MH average length of stay is 8.0 days. At a state level, the average MH length of stay ranges widely, from 4.0 to 14.0 days. Nationally, the SA average length of stay is 4.8 days, but at the state level ranges from 3.2 days to 6.2 days.
MHSA Hospitalizations by Sex: Women account for 53% of hospital stays for mental health conditions. Men account for 67% of hospital stays for alcohol or drug abuse related disorders. For all other (non-MHSA) conditions, 59% of hospital patients are female.
MHSA Hospitalization by Age: About half of all mental health or substance abuse related hospital stays are for patients between 18 and 44 years old. For all other (non-MHSA) conditions, only about 25% of patients are ages 18 to 44. While 36% of non-MHSA hospital stays are for patients age 65 or older, only about 8% of MHSA stays are for seniors.
MHSA Hospital Stays by Payor: State Medicaid programs are the largest payors of both mental health and substance abuse related hospitalizations: 28% of MH stays and 26% of SA stays are for Medicaid beneficiaries. Uninsured patients account for 9% of MH stays and 21% of SA stays. For other (non-MHSA) conditions, about 18% of hospitals stays are covered by Medicaid and about 5% of hospitalizations are uninsured.