Goldberg D
Institute of Psychiatry, de Crespigny Park, London, UK.
Int Clin Psychopharmacol. 1995 Jan;9 Suppl 5:29-34. doi: 10.1097/00004850-199501005-00006.
Care in the community has consistently been found to be cheaper, and has often been found to be better, for selected patients on demonstration sites. Most cost advantages are obtained by shortening or even eliminating the initial period of in-patient care. Health economists can compute cost equations which relate clinical characteristics of patients to treatment costs incurred later. As old long stay patients are discharged, a degree of cost inflation is inevitable for both the hospital and the community service. Strong links have been shown both between costs and client needs, and costs, and client outcomes. Integrating mental health services with primary care has been shown to increase total costs of the service, but to decrease costs per treated case. One weakness of CMH schemes is that they are vulnerable to sudden cutbacks, so that the shift of resource to the community may not actually occur. The evidence about the efficacy of case management is conflicting, but day-care can be used as a method of shortening initial admission for some patients.
一直以来，人们发现社区护理对示范项目中的特定患者而言成本更低，而且通常效果更好。大多数成本优势是通过缩短甚至消除住院护理的初始阶段获得的。卫生经济学家可以计算成本方程，将患者的临床特征与后期产生的治疗成本联系起来。随着长期住院的老年患者出院，医院和社区服务的成本必然会出现一定程度的上涨。成本与客户需求以及成本与客户结果之间都已显示出紧密联系。将心理健康服务与初级保健相结合已显示会增加服务的总成本，但会降低每个治疗病例的成本。社区心理健康（CMH）计划的一个弱点是它们容易突然削减，因此资源向社区的转移可能实际上不会发生。关于病例管理效果的证据相互矛盾，但日托可以用作缩短某些患者初始住院时间的一种方法。
