Private, voluntary or public? Comparative cost-effectiveness in community mental health care

Two prominent features of mental health policy in the UK in recent years ha ve been the rundown of hospital provision and the changing of the balance b etween public and other provider sectors. This article examines the cost, q uality of care and outcome implications. Public,voluntary and private provi ders of mental health care are compared, based on a long-term study of peop le moving out of psychiatric hospitals in London. Costs are found to be low est in the private (for-profit) sector, and highest in the NHS and consorti um (NHS and voluntary sector partnership) sectors. However, quality of care indicators suggest that the lowest cost sector is performing least well, a nd the highest cost sectors offer the best quality. These are associated wi th some differences in user outcome.