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the CPI to 1991 levels. 



Psychiatric Hospital Inpatient Costs 



Since the National Hospital Discharge Survey only includes general hospitals, we employed a 

 different method to estimate substance abuse-related Medicaid psychiatric hospital inpatient costs. 

 The 1991 Survey of the National Association of Psychiatric Health Systems indicates that 1 1 % 

 of patients in their facilities had a primary diagnosis of alcohol or substance-related disorders. 

 Multiplying this percentage by 1991 Medicaid expenditures on psychiatric inpatient care, we 

 estimated that substance abuse-related Ulness in psychiatric hospitals accounted for $238 million 



in Medicaid costs in 1991. 



'•'■■,..-' 

 This is a conservative estimate of substance abuse's impact on psychiatric hospitals. Psychiatric 

 hospitals often do not list substance abuse as the primary diagnosis because many insurers wUl 

 not pay for psychiatric care unless the primary diagnoses is a specific psychiatric disorder. A 

 large percentage of the psychiatric inpatient population are dual-diagnosed with a psychiatric 

 disorder as the primary diagnosis and a substance abuse disorder as the secondary diagnoses. 

 The limitations of our data restricted us from estimating the costs of these clients, but 

 anecdotally we know that the dual-diagnosed population is increasing and that these clients use 

 a much greater percentage of psychiatric hospital staff resources. 



Underestimation Issues 



These estimates of the cost of substance abuse to Medicaid are likely to be lower than the actual 



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