Glover G R, Rohde J, Farmer R D
Academic Department of Public Health and Epidemiology, Charing Cross and Westminter Medical School, London.
BMJ. 1993 Apr 10;306(6883):987-90. doi: 10.1136/bmj.306.6883.987.
For the past decade patients with learning disabilities living in long stay mental handicap hospitals have been resettled in the community. Local authorities have also taken on the care of new patients who would once have been long stay residents. The imperfect data that are available suggest that in England about half the residents in mental handicap hospitals in 1981 are now the responsibility of local authorities; the figures for Wales and Northern Ireland are 38% and 33%. Data on revenue suggest that the savings to the health service are much less--perhaps 9% in Northern Ireland and 3.6% in England, although there have also been capital gains through the sale of hospitals. Existing methods of transferring money from health to local authorities--joint finance and "dowries" for individual patients--do not seem adequately to have compensated local authorities. Moreover, as patients still to be transferred are more severely disabled local authorities will require larger sums--about 26 000 pounds per patient per year plus 39 200 pounds in capital. If the government chooses not to transfer these resources from health authorities it will be switching funds away from learning disabled people to other care groups.
在过去十年中，长期居住在智力障碍精神病院里的患者已被安置到社区。地方当局还承担起了对那些曾经长期住院患者的新患者的护理工作。现有的不完整数据表明，在英格兰，1981年智力障碍精神病院里大约一半的住院患者现在由地方当局负责；威尔士和北爱尔兰的这一比例分别为38%和33%。收入数据显示，对医疗服务部门的节省要少得多——北爱尔兰或许为9%，英格兰为3.6%，尽管通过出售医院也有资本收益。现有的从医疗部门向地方当局转移资金的方法——联合融资和为个别患者提供“嫁妆”——似乎并没有充分补偿地方当局。此外，由于仍有待转移的患者残疾程度更严重，地方当局将需要更多资金——每位患者每年约26000英镑，外加39200英镑的资本资金。如果政府选择不将这些资源从卫生当局转移出去，它将把资金从学习障碍者转向其他护理群体。
