Ab. Rothbard et al., COST COMPARISON OF STATE-HOSPITAL AND COMMUNITY-BASED CARE FOR SERIOUSLY MENTALLY-ILL ADULTS, The American journal of psychiatry, 155(4), 1998, pp. 523-529
Objective: In 1989, Philadelphia began a bold experiment involving the
total shutdown of a 500-bed state hospital. This study examines the s
ervice utilization and cost of treating individuals with serious menta
l illness in a community-based care system in which the state hospital
was replaced with 60 extended acute care beds in general hospitals an
d 583 residential beds. Method: A pre-post study design was used to de
termine the utilization and cost differences before and after the stat
e hospital closed for individuals with a diagnosis of schizophrenia wh
o required extended psychiatric hospitalization following an acute car
e crisis episode in a general hospital. The number and cost of days sp
ent in general and in extended hospital and residential treatment were
compared on an episode and an annual basis. Results: The result of th
is analysis showed that after the state hospital closed, the direct tr
eatment cost of an episode of care increased from $68,446 to $78,929,
and the average annual cost of care per patient increased from $48,631
to $66,794 because of an increase in acute care hospitalization. Conc
lusions: This study suggests that an ''admission'' cohort of seriously
mentally ill patients requires an optimal mix of acute care, extended
care, and residential beds, as well as ambulatory services, in order
for cost-efficient care to be delivered during a crisis period. Determ
ining the appropriate allocation and supply of beds in different setti
ngs is essential if community mental health systems are to manage the
care of individuals with serious mental illness outside of institution
al settings.