Equally disturbing was the lack of accountability. There was little, if any, oversight of the services being delivered and few standards for quality of care. Stories about individuals remaining hospitalized for months or years with only slight improvement were not uncommon. Treatment was likely to be tailored to a patient's insurance benefit rather than to the individual clinical situation, and insurance companies simply paid up to the benefit limit without asking questions about medical necessity and appropriateness and quality of care, clinical outcome, or patient satisfaction. When benefits and other personal resources were exhausted, patients with serious mental illness had only the public health system as an alternative and faced waiting lists for state hospitals and community clinics.