Psychiatric hospital length of stay for medicaid clients before and after managed care

Managed care systems allegedly discharge psychiatric inpatients "quicker and sicker" than fee-for-service programs. Study subjects were admitted to a general hospital that served adjacent counties. During 1994, both counties operated fee-for-service Medicaid mental health systems. In 1995, one county remained fee-for-service and the other assumed inpatient financial risk. Lengths of stay declined in both counties between 1994 and 1996. Managed care patients had longer lengths of stay than their fee-for-service counterparts (even after adjustment for confounders). Secular trends and practice patterns may influence length of stay more than managed care.