Personal Social Services Research Unit, London School of Economics and Political Science, London, UK.
Health Soc Care Community. 2011 Mar;19(2):113-25. doi: 10.1111/j.1365-2524.2010.00969.x. Epub 2010 Dec 10.
Many European mental health systems are undergoing change as community-centred care replaces large-scale institutions. We review empirical evidence from three countries (UK, Germany, Italy) that have made good progress with this rebalancing of care. We focus particularly on the economic consequences of deinstitutionalisation. A systematic literature review was conducted using a broad search strategy in accordance with established guidelines. We searched the International Bibliography of the Social Sciences, Health Management Information Consortium, British Nursing Index and PUBMED/Medline to 2008. The on-line search was supplemented by advice and assistance from contacts with government departments, European Commission, professional networks and known local experts. Community-based models of care are not inherently more costly than institutions, once account is taken of individuals' needs and the quality of care. New community-based care arrangements could be more expensive than long-stay hospital care but may still be seen as more cost-effective because, when properly set up and managed, they deliver better outcomes. Understanding the economic consequences of deinstitutionalisation is fundamental to success. Local stakeholders and budget controllers need to be aware of the underlying policy and operational plan. Joint planning and commissioning or devolving certain powers and responsibilities to care managers may aid development of effective and cost-effective care. People's needs, preferences and circumstances vary, and so their service requirements and support costs also vary, opening up the possibility for purposive targeting of services on needs to improve the ability of a care system to improve well-being from constrained resources. As the institutional/community balance shifts, strategic planning should also ensure that the new care arrangements address the specific contexts of different patient groups. Decision-makers have to plan a dynamic community-based system to match the needs of people moving from institutions, and must take the long view.
许多欧洲的精神卫生系统正在发生变化，以社区为中心的护理取代了大规模机构。我们回顾了三个在这种护理平衡方面取得良好进展的国家（英国、德国、意大利）的经验证据。我们特别关注去机构化的经济后果。根据既定的指导方针，我们使用广泛的搜索策略进行了系统的文献综述。我们在 2008 年之前在国际社会科学文献目录、健康管理信息联合会、英国护理索引和 PUBMED/Medline 中进行了搜索。在线搜索还得到了政府部门、欧盟委员会、专业网络和知名当地专家的建议和帮助。一旦考虑到个人的需求和护理质量，以社区为基础的护理模式并不比机构更昂贵。新的以社区为基础的护理安排可能比长期住院护理更昂贵，但仍可能被视为更具成本效益，因为如果正确建立和管理，它们可以带来更好的结果。了解去机构化的经济后果是成功的基础。地方利益相关者和预算控制者需要了解潜在的政策和运营计划。联合规划和委托或将某些权力和责任下放给护理管理者，可能有助于制定有效和具有成本效益的护理计划。人们的需求、偏好和情况各不相同，因此他们的服务需求和支持成本也各不相同，这为根据需求有针对性地提供服务提供了可能性，以提高护理系统从有限资源中改善幸福感的能力。随着机构/社区平衡的转变，战略规划还应确保新的护理安排能够应对不同患者群体的具体情况。决策者必须规划一个动态的以社区为基础的系统，以满足从机构中转移出来的人们的需求，并必须着眼于长远。
