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Study documents dumping of psychiatric patients

Yale Medicine Magazine, 1998 - Winter/Spring


Two-thirds of psychiatric hospitals providing inpatient mental health care in the United States are reported to dump patients for economic reasons, according to a Yale/Harvard study published in the journal Health Services Research.

Patient dumping is the practice by which hospitals transfer unprofitable patients, specifically those without insurance coverage, to public hospitals and community mental health centers (CMHCs), which are required by law to care for these patients after private financial resources have been exhausted. This is the first national analysis of the factors that promote or constrain economically motivated transfers of patients in relation to competitive pressures, hospital ownership and managed care practices.

"This form of patient dumping appears to be substantially exacerbated by increased competition among hospitals and reductions in the capacity of state-run psychiatric hospitals," Mark J. Schlesinger, Ph.D., associate professor of public health at Yale, and colleagues from Harvard University's Kennedy School of Government wrote in the journal's December issue.

In addition to tax exemptions, the primary way hospitals subsidize care for patients without coverage is through profits made by treating insured patients. This practice has become increasingly difficult in recent years with the growth of managed care and other methods implemented to reduce the cost of health care delivery, such as the use of the prospective payment system for Medicare and other insurers, utilization review by insurance companies, and reduced public compensation pools.

The researchers found that 25 percent of the survey respondents (directors of CMHCs) reported a great deal of dumping occurred in their service area, with slightly more than half of those patients transferred on economic grounds. Twenty-two percent of the CMHCs reported substantial adverse effects on their agencies due to dumping. Seventy-five percent reported that transfers based on economic grounds were more likely to occur from for-profit hospitals.