This issue of the Journal contains a research review by Walsh, Green, and Kastner (2003) on cost comparisons of institutional and community services. The response that follows by the Developmental Disabilities Quality Coalition-DDQC (Eidelman, Pietrangelo, Gardner, Jesien, & Croser, 2003), a consortium of nine national groups, refers to an Executive Summary that has been widely distributed by Voice of the Retarded (VOR), a group that provided financial support for the research review.
I first became aware of VOR's Executive Summary when I was contacted in July 2002 by several people in Washington, DC, who inquired about whether the Walsh et al. article was forthcoming in the Journal. (I confirmed that it was but declined to provide copies.) A copy of this Executive Summary was sent to me, along with “Talking Points and Action Steps” prepared by VOR, in which the summary was described as an advocacy tool to use with policy makers to oppose the “aggressive push towards deinstitutionalization.”
I subsequently accepted for publication the following response by the DDQC (Eidelman et al., 2003) to VOR's Executive Summary. This response is not, and should not, be interpreted to be a critique of the Walsh et al. article published in this issue. The response is directed at the Executive Summary and the advocacy materials distributed by VOR. The authors of this response could not comment on the Walsh et al. article or criticize their methodology and findings simply because the article was not available to them.
The reason I accepted the DDQC response is that VOR's Executive Summary has been disseminated to policy makers and discussed in policy circles. In the materials by VOR, numerous references were made to the fact that the research review was forthcoming in a peer-reviewed journal and implied that this review countered one of the major arguments in favor of deinstitutionalization and community inclusion. The DDQC response provides a different perspective on the relevance of cost in the institution versus community debate.
In VOR's Executive Summary a footnote was included signifying that “a slightly modified manuscript has been submitted for publication.” The manuscript accepted for publication in the Journal is not a “slightly modified” version of the Executive Summary. The Executive Summary is missing the essential information—the methodology, the list of studies reviewed, the interpretations of the findings of these specific studies—to enable the research and scholarly community to evaluate the research reviewers' conclusions. No single study or research review is ever definitive or conclusive. Readers of this and other journals know that published articles sometimes generate responses or stimulate additional research and analyses in which other researchers come to conclusions opposite to those in the originally published work. This is why authors of peer-reviewed research articles are expected to provide specific descriptions of their methodology.
The contribution of Walsh et al. (2003) in their research review, in my opinion, is that they draw attention to the complexity of cost comparisons and identify some of the major factors that should be taken into consideration. For example, Walsh et al. pointed out that lower costs in community settings often reflect differentials in staffing costs. Staff members at state-operated institutions tend to receive higher wages and benefits than do workers at privately operated community settings. Walsh et al. noted, and I agree, that the lack of parity in wages and benefits between workers at institutions and community settings is not a “desired efficiency,” but it is not a foregone conclusion that parity will be achieved in the foreseeable future.
When I made the decision to accept Walsh et al.'s research review, I was not influenced by the potential political implications of publishing the article. I never am when making editorial decisions on manuscripts submitted for peer-review.
Any set of findings or facts can lead to different conclusions and policy implications. If Walsh et al.'s (2003) article suggests that community settings are not inherently less expensive than are institutions, then it also refutes claims that institutions offer “economies of scale” or that the centralization of services at institutions is more cost-effective. The “institutional bias” of the federal–state Medicaid program, alluded to by Walsh et al., cannot be justified on fiscal grounds.
I consider the Walsh et al. (2003) research review to be a valuable addition to the literature on cost analysis of developmental disability services and hope that readers will evaluate it according to its contribution to the field by identifying factors that should be considered in cost comparisons. It would be unfortunate if people in the field viewed it as ammunition in a political debate. This is not why I accepted this research review for publication, and it is not what I think that we can learn from it.—S.J.T.
Editor's Note: The American Association on Mental Retardation (AAMR) is a member of the Developmental Disabilities Quality Coalition. Editorial decisions on manuscripts submitted to the Journal are made without regard to the position statements of AAMR. The Board of Directors and personnel from the National Office of AAMR have never attempted to influence the editorial decision-making process of the Journal. Further, when this response was originally accepted, AAMR was not associated with it.