The 130th Annual Meeting of APHA

Abstract #41191

Bleddyn P. Davies Davies, MA DPhil and José-Luis Fernandez Fernandez, MA. PSSRU, London School of Economics, Houghton Street, London, WC2 2AE, England, 44 1227 827634, B.P.Davies@ukc.ac.uk

Users of community of care and their caregivers differ in their prioritisation of benefit from using services, but producing different outcomes require different service mixes. What do the relations between service inputs and outcomes and current patterns of inefficiency in the mixing of inputs given productivities and prices imply to be the consequences of alternative policy choices for improving equity and efficiency of outcomes of publicly-subsidised care in different market conditions? Methods: [a] Estimate reduced form equations for a production function with seventeen 'final outputs': outcomes of evaluative significance in their own right for users and family caregivers. Equation forms allow for the complexity of the relationship between user and caregiver risk factors and the productivities of services. [b] Apply optimisation techniques to simulate the service mix which given the same overall expenditure, most efficiently maximises each of three outputs: extended community stays, user satisfaction and reduced felt burden of care-giving. The analyses show the differences between actual and optimal patterns for input mixes, total package costs, and levels of the final output, and for six user types. [c] Show 'collateral outputs': effects of optimising on one output given supply conditions on other final outputs. Data used: PSSRU's ECCEP project's collection, particularly interviews after first receipt of services and six months later with a cohort of 419 new users, their main caregivers and care managers; continuous data on utilisation and costs of community health and social services; and prioritisation rankings derived from interviews with 150 managers of the ten social services departments in England and Wales in which the sample of new users were drawn. Results: patterns vary greatly according to output maximised and service supply conditions. Great supply inelasticity or constraints on the availability of newer forms of service severely reducing the potential gains from improving efficiency in mixing inputs. Conclusions: policies must aim to [a] so manage the market as to maximise supply flexibility, [b] further remove incentives which at the field level distort allocation and consumption decisions, and [c] create arrangements which balance the capacity of the care managers to respond to complex variations in circumstances of users and caregivers, with clear prioritisations of the outputs to be aimed at given case circumstances, and cultures in which the care managers will respond to opportunities and appropriate incentives progressively to improve equity and efficiency.

Learning Objectives:

• At the end of the session, the participants will be able to
• - describe why the repertoire of production function modelling is appropriate for use in the topic area
• - to what degree and for users in what circumsances would the achievement of some other goals are likely to be impaired if the mix of services is most efficient for achieving one goal

Keywords: Evaluation, Community-Based Care

Related Web page: www.ukc.ac.uk/pssru/PDFfiles/eepflyer.pdf

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.