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Costs and Benefits in Patient Care

Malcolm Sills, MD
Arch Gen Psychiatry. 1981;38(5):598-599. doi:10.1001/archpsyc.1980.01780300110013.
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To the Editor.—  Stein, Test, and Weisbrod (Archives 1980;37:392-397, 400-405, 409-412) are to be congratulated on their series of reports comparing traditional hospital-type treatment with community treatment. The "Economic Benefit-Cost Analysis" (pp 400-405) is particularly pertinent. About six years ago, when we closed a large state hospital and established community programs with the available resources, we tried to "follow the dollars" as well as follow-up the patients, but we were finally defeated by the seemingly endless number of variables involved. The authors come close to capturing all these variables.However, when talking about money, mental health administrators have to talk to government officials. Although the authors do make it clear that their analysis is not a "government-budget benefit-cost analysis," the use of their study with state executives or legislators could lead to problems. When these budget people are told that community programs either save money or, at least, break even


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