Availability and Performance of Psychiatric Acute Care Facilities in California From 1992 to 1996

OBJECTIVE: The acute care psychiatric hospital industry has been challenged by managed care, government policies, and marketplace competition to control rising costs. This study examined changes in the availability and performance of acute care psychiatric delivery facilities in California between 1992 and 1996. METHODS: A retrospective longitudinal research design was used. Data on facilities, licensed psychiatric beds, discharged patients, days of care, occupancy, average length of stay, licensure, and type of ownership for the years 1992, 1994, and 1996 were purchased from the California Office of Statewide Health Planning and Development. Data were analyzed using numerical description and percent-change calculations. RESULTS: Between 1992 and 1996 licensed beds, days of care, and average length of stay decreased in acute psychiatric facilities and services, while psychiatric discharges and facility occupancy increased. The for-profit sector and the specialty acute care sector experienced large decreases in facilities, licensed beds, days of care, and average length of stay. The generalist sector—general psychiatric units licensed within acute general hospitals—and not-for-profit facilities experienced large increases in discharges. CONCLUSIONS: Challenges to institution-based services for the mentally ill population now extend beyond the state hospital system to include community-based acute care psychiatric hospital services. Recent declines in the for-profit, acute care psychiatric hospital specialty sector and the success of the generalist and not-for-profit sectors demonstrate the lack of uniform responses to environmental pressures. However, changes in federal Medicare reimbursement policy enacted in the Balanced Budget Act of 1997, as well as competition from alternative providers, are likely to result in further closures of all types of acute care psychiatric facilities over the next few years.