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Costs and Benefits in Patient Care-Reply

Leonard I. Stein, MD; Burton Weisbrod, PhD; Mary Ann Test, PhD
Arch Gen Psychiatry. 1981;38(5):599. doi:10.1001/archpsyc.1980.01780300111014.
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The desire for an analysis of the complex flow of funds associated with alternative therapy programs is understandable and, in some instances, even critical. However, to answer Dr Sills's letter requires that we clarify two points. First, we did not compare "traditional hospitaltype treatment" with community treatment. Our comparison was between what is currently conventional treatment (ie, progressive, short-term hospitalization plus aftercare) and a very intensive community treatment model that utilized the community rather than the hospital as the primary locus of care, resulting in enhanced patient functioning and a significant reduction of hospital use. This clarification is important because with conventional treatment most patients are out of the hospital most of the time anyway (as were the patients in our control group). Longterm hospitalization for the emerging generation of patients with chronic mental illness is no longer current practice, and we believe that given the present emphasis on patient's


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