Partial Psychiatric Hospitalization Program Availability in Nonmetropolitan and Metropolitan Hospitals Nationally
To determine the availability of partial psychiatric hospitalization programs (PPHPs) availability, we conducted analyses of the 2016 American Hospital Association (AHA) Annual Survey of Hospitals, which uses the U.S. Census Bureau's core-based statistical area criteria to classify hospitals according to location in a metropolitan, micropolitan, or noncore nonmetropolitan county. For this analysis, we combined micropolitan and noncore nonmetropolitan hospitals into a single nonmetropolitan category.
More than one-third (38.7%) of all metropolitan hospitals offer any PPHP (i.e., a PPHP offered by the hospital, affiliated healthcare system, or joint venture between the hospital and another entity). In contrast, only 11.4% of nonmetropolitan hospitals offer PPHPs, a statistically significant difference (P < .0001). We also looked at characteristics of hospitals offering hospital-based PPHPs versus hospitals offering PPHPs at another site through an affiliated healthcare system or joint venture. Regardless of location, hospitals offering hospital-based PPHPs on average have more total, licensed, and psychiatric beds as well as higher inpatient admission volumes than those offering PPHPs elsewhere in their healthcare system or through a joint venture (P < .0001 for each). Also, significantly higher proportions of nonmetropolitan and metropolitan hospitals with a residential psychiatric unit offered hospital-based PPHPs than affiliated PPHPs (P < .0001).
The wide range of services involved in PPHPs means providers offering these programs must commit substantial, often limited, resources to them. This could be problematic in nonmetropolitan areas where low revenues and staff shortages are more typical. Indeed, fewer than 5% of nonmetropolitan hospitals included in this study offer these programs in-house. Furthermore, we found that both nonmetropolitan and metropolitan hospitals that provide PPHPs in-house had significantly higher patient volumes and capacities than those that did not directly offer the programs in the hospital. This suggests that patients who do not live near larger hospitals may have limited or no access to PPHPs.
Because Medicare and most Medicaid programs cover PPHP services, our findings have potential implications for federal and state health policies aimed at improving access to mental health services. Nonmetropolitan counties are disproportionately older than metropolitan counties, meaning a larger share are currently covered by, or will soon be eligible for, Medicare coverage. The relative scarcity of PPHPs in nonmetropolitan hospitals suggests that additional programs or policies are warranted to ensure nonmetropolitan residents' access to psychiatric services.