Leaving hospital II: the cost-effectiveness of community care for former long-stay psychiatric hospital patients

The replacement of long-stay hospital services with community-based care can have considerable resource consequences. How much community care costs and whether it is more expensive than hospital care are questions high on the policy and planning agenda. Decision-makers should also be interested in whether levels of expenditure are associated with clients' needs and with changes in their wellbeing. These questions were addressed in a wide-ranging evaluation of community care in N. Ireland. In examining the costs of accommodation and other services used by former residents of nine hospitals (n=133) the study found community care to be cheaper than hospital care. Broadly speaking, the new service was a cost-effective alternative as little change in clients' welfare was found. However, analysis of the variations in community care costs found only weak associations with clients' personal characteristics and needs, and found no link between differential spending and differential outcomes.