Inpatient Psychiatric Hospitalization in Texas 1999 to 2010

The primary purpose of the study was to examine the role public sector payers (Medicare and Medicaid) and providers (Texas state mental health hospitals) play in psychiatric hospitalization, using Texas annual hospital discharge files from 1999 to 2010. Psychiatric hospitalization, as defined by a primary behavioral health diagnosis (ICD-9 diagnoses 290-314.99) averaged 146,876 discharges per year, approximately 5.24% of all hospitalizations in the state. Children younger than 18 years accounted for 27,035 discharges per year. The top 4 diagnostic groups were depression (29%), bipolar disorder (22%), schizophrenia (18%), and alcohol-drug disorders (14%). More patients with schizophrenia or other psychotic disorders were served by the public sector, while more patients with depression or alcohol-drug disorders were served by private insurance. Interestingly, patients with bipolar disorder were distributed relatively evenly across both payment groups and ages. Length of stay decreased from 10.5 days in 1999 to 8.1 days in 2010. Most psychiatric discharges (69%) were served by a small group of 42 large psychiatric hospitals.