Comparative cost analysis: Community-based services as an alternative to institutions
Comparative cost analysis: community based services as an alternative to institutions
Martin Knapp, London School of Economics
The project is led by the Tizard Centre and PSSRU (London School of Economics) but works with partners in Spain (PSICOST, Jerez, Spain), Germany (University of Siegen), Czech Republic (Charles University, Prague, and Belgium (the Catholic University of Leuven and EASPD).
The project partners will consult with a reference group made up of representatives from Open Society Institute, Inclusion Europe, European Disability Forum, Mental Health Europe, Autism Europe and the European Commission.
Aims & Objectives
The overall aim of the project is to provide scientific evidence to inform and stimulate policy development in the reallocation of financial resources to best meet the needs of people with disabilities, through a transition from large institutions to a system of community-based services and independent living.
The objectives of the project are to:
1. Collect, analyse and interpret existing statistical and other quantitative data on the number of people with disabilities placed in large residential institutions (institutions where more than 30 people live, of whom at least 80% are disabled), including the type of disabilities concerned, the age and gender of residents, the nature of the services received and the number, type and qualification of staff involved, in 28 European countries.
2. Analyse the economic, financial and organisational arrangements necessary for an optimal transition from a system of large institutions to one based on community services and independent living, using three countries (England, Germany and Italy) as case studies to illustrate the issues involved.
3. Report on the issues identified in Phases 1 and 2, in a form suitable for stakeholders and policy-makers, together with an executive summary targeted at the general public that could be incorporated into the second regular report of the Commission on the situation of people with disabilities. In addition to the results of the project, the report will specifically address
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Phase 1 will involve a review of European and international data sources and the development of template for data collation. Once the template has been designed, researchers in each country will identift and collate existing national data sources, making contact with relevant government departments using the advice and assistance of the Commission and existing professional networks.
The countries covered in this project will be:
|Countries to be covered||Partners responsible|
|UK, Ireland, Denmark, Malta, Sweden and Finland||University of Kent/London School of Economics|
|Austria, Germany, Lithuania, Latvia, Estonia, Slovakia and Slovenia||University of Siegen|
|Spain, Portugal, Italy, Greece, Turkey and Cyprus||PSICOST, Spain|
|Czech Republic, Romania, Poland, Hungary and Bulgaria||Charles University, Prague|
|Belgium, France, Netherlands, Luxembourg||Catholic University of Leuven/EASPD|
Researchers in each country will clarify the definitions used in different data sources, will collate the data on the number and characteristics of people in institutional care and will examine the comprehensiveness/completeness of the data from each country,
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Phase 2 will involve 5 main tasks:
Task 1: Description of the sequence and process of service development within three case studies (
England, Germany and Italy).
Task 2: Identification of the roles of different actors in the process ( for example, the relationship between national, regional and local tiers of government in the process, in terms of leadership, co-ordination and management of financial flows, and the role of disabled people, their families and representatives in promoting, guiding and supporting the transition from institutional to community-based services).
Task 3: Comparison of the costs of community-based vs. institutional services using a methodological approach that ensures that all relevant resources are identified, their costs calculated, and the resultant figures interpreted in light of the characteristics of service users, the quality of care and (where possible) the outcomes they achieve (Knapp 1990; Hallam and Knapp 2004).
Task 4: Identification of transitional cost (eg 'double-running') issues
Task 5: Analysis of political and economic strategies used to manage costs and wider economic issues arising during the transition from institutional to community-based care.
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Phase 3 involves the compilation of the final report incorporating material contributed in Phase 1 by the partners of the consortium and the results of Phase 2. Interpretation of the results and their implications will be strengthened by using the reference group as a 'sounding-board'. Content of the full report will also be shaped by the response of the Commission to the interim report.
Ongoing - project is due for completion October 2007
The European Commission