Healing Medicare Hospital Recidivism: Causes and Cures

The role of Medicare in our national market for acute care hospital services is that of a power buyer. Medicare beneficiaries in 2008 included some 45.2 million people. Total benefits paid in 2008 were $462 billion, including 29% of all hospital spending. Medicare's dominance in the buyer's market for acute care hospital beds renders the program particularly wellsuited to scrutinize the role of acute care hospital services in producing effective and efficient outcomes for Medicare beneficiaries. “[I]f there are to be far-reaching changes in the way medicine is practiced in this country, Medicare will have to drive them.” It is a historical irony that a program, a scaled-down version of national health insurance, could have grown to this power buyer status; but the history of Medicare is full of ironies—the greatest of which may prove to be that Medicare reforms now sit at the very center of the funding mechanisms for the 2010 Patient Protection and Affordable Care Act (PPACA).

Involuntary out-patient commitment and reduction of violent behaviour in persons with severe mental illness

BackgroundViolent behaviour among persons with severe mental illness (SMI) causes public concern and is associated with illness relapse, hospital recidivism and poor outcomes in community-based treatment.AimsTo test whether involuntary out-patient commitment (OPC) may help to reduce the incidence of violence among persons with SMI.MethodOne-year randomised trial of the effectiveness of OPC in 262 subjects with psychotic or major mood disorders and a history of hospital recidivism. Involuntarily hospitalised subjects awaiting OPC were randomly assigned to release or court-ordered treatment after discharge. Those with a recent history of serious assault remained under OPC until expiry of the court order (up to 90 days); then OPC orders were renewed at clinical/court discretion. Control subjects had no OPC. Four-monthly follow-up interviews with subject, case manager and collateral informant took place and service records were collected.ResultsA significantly lower incidence of violent behaviour occurred in subjects with ⩾6 months' OPC. Lowest risk of violence was associated with extended OPC combined with regular out-patient services, adherence to prescribed medications and no substance misuse.ConclusionsOPC may significantly reduce risk of violent behaviour in persons with SMI, in part by improving adherence to medications while diminishing substance misuse.

The efficacy of a psychiatric halfway house: a study of hospital recidivism and global outcome measure

SummaryThe authors investigated the post-halfway house outcome of a sample of 41 former residents of the halfway house of the Department of Psychiatry, Athens University. Two criteria were used: hospital recidivism and global ratings of outcome (which was assessed on the basis of three parameters: rehospitalization, employment and independent living). Mean duration from the time of departure was 32 months (range: 8–52 months). Within this period good outcome and non-recidivism were related with compliance to pharmacotherapy. Most recidivists also had a shorter stay in the halfway house and cases with successful outcome tended to be evaluated higher on the “Behaviour in Halfway House Scale” at the end of the residency.