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A letter from America: rescuing inpatient psychiatry
  1. J C Markowitz
  1. Professor J C Markowitz, Research Psychiatrist, New York State Psychiatric Institute; Clinical Professor of Psychiatry, Weill Medical College of Cornell University, New York, USA; Jcm42{at}

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In recent decades, American insurance companies have severely restricted medical reimbursement and access to treatment. Within this general trend, they have discriminated against psychiatry more than most other specialties, and have slashed in particular the most expensive facet of psychiatric care: inpatient treatment.1 The mean length of psychiatric stay in American hospitals has fallen from months to a handful of days. Realistically, how effectively can clinicians treat severely ill psychiatric patients in a three or four day hospital stay? Meanwhile, reimbursement for inpatient care has fallen so low (in some cases to 39% less than actual costs) that American hospitals have begun reducing psychiatric beds as well as lengths of stay.2 Patients in managed care plans are less likely to receive inpatient care than patients in fee-for-service plans.3

This drastic change in inpatient psychiatric care has had little to do with its clinical effectiveness and much to do with the managed care mantra of cost cutting. The promise that increased reimbursement for less costly day hospitals and outpatient services would compensate for this …

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  • Competing interests: None.

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