Comparing Costs of Hospital and Community Care

Cassell, Wilfred A.; Smith, Colin M.; Grünberg, Fréderic; Boan, Jack; Thomas, Ronald F.

doi:10.1176/ps.23.7.197

Cited by 10 publications

(4 citation statements)

References 6 publications

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“…Thus, the simple comparisons of hospital and community welfare and costs for the group of leavers reveal that community care is noticeably less costly than hospital for this cohort, and at least as good as hospital in maintaining standards of client welfare. This result is thus in line with the North East Thames study findings (see section 5 above), and consistent with the US results of, inter alia, Weisbrod et al (1980), Cassel et al (1972, and Murphy & Datel (1976), although these are concerned with different policy contexts. It was also found, not surprisingly, that the most dependent clients received packages of services which were more costly than hospital, again consistent with our NETRHA findings (see Table 5 for evidence) and with Hafner & an der Heiden (1989).…”

Section: The Outcomes Of the Care In The Community Programmesupporting

confidence: 91%

Costing mental health services

1990

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SynopsisIn this paper four principal topics are addressed: (a) the policy and political contexts in which demands arise for cost information; (b) the nature and phasing of those demands; (c) the basic rules of empirical costs research for meeting those demands; and (d) concomitant implications for the design, execution and interpretation of their research. Mental health care policy or practice changes which ignore costs, or which embody cost information without obeying or recognizing the four basic rules, can only be of dubious validity, or can only be used to answer a limited range of questions. But, as the illustrative studies show, it need not be an horrendous, or ideologically compromising or scientifically complex task to add a cost dimension to the evaluation of mental health services. There are enough examples in the literature of bad costs research to demonstrate that it is not as simple as some people think, but there are also enough examples of good research t o encourage further attempts.

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Section: The Outcomes Of the Care In The Community Programmesupporting

confidence: 91%

Costing mental health services

1990

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“…It was also clear that for acute illnesses, short-term hospitalization-two to four days-and immediate return to the community "will not only be expected, but also required" (290). Further, articles with early data were indicating that individuals who had chronic mental disorders could be cared for less expensively in the community than in the hospital (291)(292)(293)(294).…”

Section: Economicsmentioning

confidence: 99%

The Last Half-Century of Psychiatric Services as Reflected in Psychiatric Services

Geller¹

2000

135

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The last half-century of psychiatric services in the United States is examined through developments and trends reported in the 50 years of publication of Psychiatric Services. The journal, earlier named Mental Hospitals and then Hospital and Community Psychiatry, was launched by the American Psychiatric Association in January 1950 and marks its 50th anniversary this year. The author organizes his review of psychiatric services largely around the locus of care and treatment because the location of treatment--institution versus community--has been the battleground for the ideology of care and for the crystallization of policy and legal reform. He uses "dehospitalization" to describe the movement of patients out of state hospitals, rejecting the widely used term "deinstitutionalization" as inappropriate; one reason is that the term wrongly implies that many settings where patients ended up were not institutional. Also covered in detail, as reflected in the journal, are community care and treatment, economics, patient empowerment, and the interface issues of general hospitals, outpatient commitment, and psychosocial rehabilitation. The author notes that some concepts, such as outpatient commitment and patient empowerment, emerged earlier than now assumed, and that others, like psychosocial rehabilitation, recurred in slightly different forms over time. He concludes that even after 50 years of moving patients out of state hospitals and putting them somewhere else, mental health policymakers and practitioners remain too myopically focused on the locus of care and treatment instead of on the humaneness, effectiveness, and quality of care.

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“…Several studies have suggested that, as might be expected, care of patients in the community is considerably cheaper than hospital care, but they have not, on the whole, taken into account the 'intangible' costs or benefits to the patients and their families (Cassell et al 1972;Murphy & Datel, 1976;Sharfstein & Nafziger, 1976). Our study does attempt to contrast these 'intangible' (in our terms 'soft') costs and benefits with analysis of the ' hard' monetary effects involved.…”

Section: Discussionmentioning

confidence: 97%

A comparison of two different services treating schizophrenia: a cost–benefit approach

1980

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SYNOPSISThis study compares the clinical and social outcome for 2 cohorts of patients who had a first admission for schizophrenia 4 years earlier. One cohort was treated in a psychiatric unit attached to a teaching district general hospital (DGH(T)), while the other was treated at an area mental hospital (AMH) with modern rehabilitation facilities. The clinical outcome for the 2 cohorts was broadly similar, but the DGH(T) imposed less of a strain on relatives, and was associated with less unmet need. The DGH unit tended to have significantly shorter durations of stay for its patients, so that its total hospital costs were less than those for the AMH despite higher unit costs. The cost benefit analysis shows that, where these particular patients are concerned, the DGH(T) unit is economically superior to the AMH despite the fact that it supports a large teaching staff, and that these economic advantages are accompanied by various non-monetary advantages.

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Comparing Costs of Hospital and Community Care

Cited by 10 publications

References 6 publications

Costing mental health services

Costing mental health services

The Last Half-Century of Psychiatric Services as Reflected in Psychiatric Services

A comparison of two different services treating schizophrenia: a cost–benefit approach

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