Equity and efficiency policy in community care : needs, service productivities, efficiencies and their implications / Bleddyn Davies, José Fernández with Bülent Nomer.

Format:

Book

Author/Creator:

Davies, Bleddyn.

Contributor:

Nomer, Bülent.

Fernández, José, 1971-

University of Kent at Canterbury. Personal Social Services Research Unit.

Language:

English

Subjects (All):

Older people--Care--Great Britain.

Older people.

Older people--Care.

Health care reform.

Evaluation.

Great Britain.

Public welfare--Great Britain.

Public welfare.

Community health services--Great Britain.

Community health services.

Health care reform--Great Britain--Evaluation.

Physical Description:

xxxvi, 458 pages : illustrations ; 23 cm

Place of Publication:

Aldershot ; Burlington : Ashgate, [2000]

Contents:

1 Introduction: Policy Context and Research Design 1

1. Contemporary policy context 3

2. The pre-reform productivities challenge 6

3. The essay and the research 10

4. Aims and the research design: collection and analysis 11

4.1. Collection design 11

4.2. Analysis design 14

Part I Mapping Productivities and Service Outputs 25

2 Modelling the Impact of Service Inputs on Outputs: Framework and Indicators 27

1. Outputs, inputs and risk factors studied 27

1.1. Outputs 27

1.2. Inputs 38

1.3. Risk factors, need-related circumstances, and other non-resource inputs affecting the relationships between resource inputs and outputs 38

3 Estimating Production Functions 43

1. Production function theory 43

2. Production functions for community care 44

2.1. Many receive only one service 44

2.2. Impact of risk factors 45

3. Production functions and causal structures 49

4. Structure of chapters 4-10 50

4.1. The production function model and the impact of risk factors 50

4.2. Service productivities 50

4 Productivities for DAYS Indicator Variable (User's Length of Stay in the Community) 55

1. The model and the impact of risk factors 55

2. Service productivities 59

3. Overall service impact, impact for groups, and equity and efficiency 61

5 Productivities for USATISF Indicator Variable (Overall Satisfaction with Services) 65

1. Degree of satisfaction of user with the level of service being received (USATISF) 65

1.1. The model and the impact of risk factors 65

1.2. Service productivities 67

1.3. Overall service impact, impact for groups, and equity and efficiency 68

2. Caregivers' degree of satisfaction with amount and type of support obtained by principal informal caregiver from the services to help them look after user (SATAMSUP) 70

2.1. The model and the impact of risk factors 70

2.2. Service productivities 71

2.3. Overall service impact, impact for groups, and equity and efficiency 73

3. Degree to which the principal informal caregiver's experience of the social services was favorable during the six months of the COCA period (PICSEXP) 73

3.1. The model and the impact of risk factors 73

3.2. Service productivities 73

3.3. Overall service impact, impact for groups, and equity and efficiency 76

6 Productivities for IMPADL, IMPIADL and NSF Indicator Variables (Perceived Improvement in Functioning in Service-Related Areas and Reported Unmet Needs) 77

1. Improvement in number of personal care functions of daily living ascribed by the user to the social services (IMPADL) 77

1.1. The model and the impact of risk factors 77

1.2. Service productivities 79

1.3. Overall service impact, impact for groups, and equity and efficiency 79

2. Improvement in number of household care and other instrumental care functions of daily living ascribed by the user to the social services (IMPIADL) 82

2.1. The model and the impact of risk factors 82

2.2. Service productivities 83

2.3. Overall service impact, impact for groups, and equity and efficiency 85

3. User's count of unmet needs for help with functional areas covered by community social services (NSF) 87

3.1. The model and the impact of risk factors 87

3.2. Service productivities 89

3.3. Overall service impact, impact for groups, and equity and efficiency 91

7 Productivities for IMPEMP, UEMPOW, CEMPOW Indicator Variables (Empowerment, Choice and Control) 95

1. User felt control over own life score (IMPEMP) 95

1.1. The model and the impact of risk factors 95

1.2. Service productivities 97

1.3. Overall service impact, impact for groups, and equity and efficiency 98

2. User's felt empowerment/influence during the set-up stage of care management scale (UEMPOW) 100

2.1. The model and the impact of risk factors 101

2.2. Service productivities 101

2.3. Overall service impact, impact for groups, and equity and efficiency 103

3. PIC's felt empowerment/influence during set-up stage of care management scale (CEMPOW) 105

3.1. The model and the impact of risk factors 105

3.2. Service productivities 105

3.3. Overall service impact, impact for groups, and equity and efficiency 109

8 Productivities for PGC, GDL, DLD Indicator Variables (General Psychological Well-being) 111

1. Overall lack of morale: the PGC score (PGC) 111

1.1. The model and the impact of risk factors 111

1.2. Service productivities 113

1.3. Overall service impact, impact for groups, and equity and efficiency 114

2. General dissatisfaction with life (GDL) 116

2.1. The model and the impact of risk factors 116

2.2. Service productivities 118

2.3. Overall service impact, impact for groups, and equity and efficiency 119

3. Dissatisfaction with life development (DLD) 121

3.1. The model and the impact of risk factors 121

3.2. Service productivities 123

3.3. Overall service impact, impact for groups, and equity and efficiency 126

4. Kosberg carer burden scale (KOSBERG) 128

4.1. The model and the impact of risk factors 128

4.2. Service productivities 128

4.3. Overall service impact, impact for groups, and equity and efficiency 133

9 Productivities for IMPREL and SATSOC Indicator Variables (Reduction in Social Exclusion and Improvement in Relationships) 137

1. Degree to which user considered social services to have improved how well user gets on with family and friends (IMPREL) 137

1.1. The model and the impact of risk factors 137

1.2. Service productivities 139

1.3. Overall service impact, impact for groups, and equity and efficiency 141

2. Degree of satisfaction of user with chances to socialise and to meet people (SATSOC) 142

2.1. The model and the impact of risk factors 142

2.2. Service productivities 144

2.3. Overall service impact, impact for groups, and equity and efficiency 145

10 Productivities for WKSAT Indicator Variable (Worker Perception of Impact) 147

1. The model and the impact of risk factors 147

2. Service productivities 149

3. Overall service impact, impact for groups, and equity and efficiency 152

11 Joint Supply in the Production System 155

1. Handling joint supply: cost function versus simultaneous production function 156

1.1. Cost function and joint supply 156

1.2. Simultaneous production function models and joint supply 159

2. Analysis of results 160

2.1. Joint supply relationships reflected in the cost function 160

2.2. Results of the simultaneous equation model 162

12 Service Productivities: the Main Patterns 165

1. Productivity patterns 165

1.1. Scale effects 165

1.2. Complementarity and substitutability 166

1.3. Differences in marginal productivities between user groups 168

2. Pattern of contribution given observed allocations 170

2.1. Package contributions across outputs 170

2.2. Service contributions across outputs 174

2.3. Service contributions and average productivities across outputs 176

Part II Equity and Efficiency: Actual and Optimal 179

13 Equity and Efficiency Analysis: Assumptions and Methods 181

1. Optimisation scenario assumptions 183

1.1. The single output optimand 183

1.2. Flexibility of service supply 186

2. Equity or inefficiency interpretation assumption 190

2.1. Aspects of efficiency 191

2.2. Utilitarianism and the equity assumption 191

3. Common structure of efficiency chapters (14-21) 193

14 Efficiencies for DAYS Indicator Variable (Users' Length of Stay in the Community) 199

1. Technical efficiency 199

2. 'Input mix' efficiency 200

2.1. Assumption (a): Resources can be shifted subject only to a total budget constraint: 'unconstrained optimisation' 200

2.2. Assumption (b): Optimisation subject to user group average budgets: 'group-budget-constrained optimisation' 208

2.3. Assumption (c): Total expenditure on each service maintained: 'Service-budget-constrained optimisation' 212

15 Efficiencies for USATISF Indicator Variable (Degree of Satisfaction of User with the Overall Level of

Service Received) 221

1. Technical efficiency 221

2. Input mix efficiency 224

2.1. Assumption (a): Optimisation subject only to the overall budget: 'unconstrained optimisation' 224

2.2. Assumption (b): Optimisation subject to user group average budgets: 'group-budget-constrained optimisation' 228

2.3. Assumption (c): Total expenditure on each service maintained: 'service-budget-constrained' optimisation 231

16 Efficiencies for IMPADL Indicator Variable (Degree of Improvement in Personal Care Functions of Daily Living Ascribed by User to Social Services) 237

1. Technical efficiency 237

2. Input mix efficiency 240

2.1. Assumption (a): Optimisation subject only to the overall budget: 'unconstrained optimisation' 240

2.2. Assumption (b): Optimisation subject to user group average budgets: 'group-budget-constrained optimisation' 243

2.3. Assumption (c): Total expenditure on each service maintained: 'service-budget-constrained' optimisation 246

17 Efficiencies for IMPIADL Indicator Variable (Degree of Improvement in Household Care and Other Instrumental Care Functions of Daily Living Ascribed by User to Social Services 253

1. Technical efficiency 253

2. Input mix efficiency 255

2.1. Assumption (a): Optimisation subject only to the overall budget: 'unconstrained optimisation' 256

2.2. Assumption (b): Optimisation subject to user group average budgets: 'group-budget-constrained optimisation' 259

2.3. Assumption (c): Total expenditure on each service maintained: 'service-budget-constrained' optimisation 263

18 Efficiencies for IMPEMP Indicator Variable (User Felt Control Over Own Life Score) 269

1. Technical efficiency 269

2. Input mix efficiency 272

2.1. Assumption (a): Optimisation subject only to the overall budget: 'unconstrained optimisation' 272

2.2. Assumption (b): Optimisation subject to user group average budgets: 'group-budget-constrained optimisation' 275

2.3. Assumption (c): Total expenditure on each service maintained: 'service-budget-constrained' optimisation 277

19 Efficiencies for DLD Indicator Variable (User Dissatisfaction with Life Development Score) 283

1. Technical efficiency 283

2. Input mix efficiency 284

2.1. Assumption (a): Optimisation subject only to the overall budget: 'unconstrained optimisation' 284

2.2. Assumption (b): Optimisation subject to user group average budgets: 'group-budget-constrained optimisation' 287

2.3. Assumption (c): Total expenditure on each service maintained: 'service-budget-constrained' optimisation 290

20 Efficiencies for KOSBERG Indicator Variable (Felt Burden of Caregiving) 295

1. Technical efficiency 295

2. Input mix efficiency 297

2.1. Assumption (a): Optimisation subject only to the overall budget: 'unconstrained optimisation' 297

2.2. Assumption (b): Optimisation subject to user group average budgets: 'group-budget-constrained optimisation' 302

2.3. Assumption (c): Budget shares of services are maintained: 'service-budget-constrained optimisation' 304

21 Efficiencies for WKSAT Indicator Variable (Worker Perception of Impact) 311

1. Technical efficiency 311

2. Input mix efficiency 313

2.1. Assumption (a): 'unconstrained optimisation' 313

2.2. Group-budget-constrained optimisation 316

2.3. Assumption (c): service-budget-constrained optimisation 319

22 The World Viewed in the Looking Glass: the System's Implicit Equity Valuations 325

1. Methodology 326

1.1. Reinterpreting the evidence 326

2. Results 327

2.1. All users 327

2.2. User group patterns 328

Part III Equity and Efficiency Policy Choices 335

Some policy propositions 336

23 'Independence' and its Aspects 337

1. Make the enhancement of the feeling of control over life the single maximand 338

2. Make one of the outputs valued by users the single maximand 341

2.1. Make the extension of the number of days users are supported in their own homes rather than in institutions for long-term care the single output maximand 342

2.2. Make the improvement of user satisfaction with services the single output maximand 344

2.3. Make improvement in functioning in the performance of the tasks of daily living the maximand 344

24 Balancing Resource Concentration and Diffusion 351

1. Context 351

2. Analysis in other countries 353

3. Five variants of the argument 355

3.1. Allocate a greater share of the total resources to packages for the less disabled without extending numbers of lower dependency (proposition 4a) 355

3.2. Allocate the same overall budget to a caseload increased by doubling the numbers in long interval need groups with the same characteristics as those now served (proposition 4b) 359

3.3. Allocate resources to many more persons of lesser disability, in doing so sharing the resources with persons in circumstances other than those of the current low disability types (proposition 4c) 362

3.4. Set budget caps on packages, and use the purchasing power released to buy services for others (proposition 4d) 367

3.5. Increase or decrease the total budget, holding the case-mix constant (proposition 4e) 373

25 Listening to the Other Players Instead: Optimising the Reduction of Caregiver Burden or Care Managers' Judged Benefits 383

1. Make reducing the burden from caregiving the maximand 383

2. Maximise what the field care manager interprets to be the greatest beneficial impact 385

3. Matching the output prioritisation to the analysis group: the role of analysis group budget-setting 388

26 Flexibility in Commissioning and Decommissioning 391

1. Implications of the optimisations 391

2. Could the unconstrained optimisation scenario be created? 392

2.1. Flexibility of substitution in the search for best value 392

2.2. Apparent elasticity of supply 393

27 Conclusions: Production of Welfare Analysis and the Convenient Assumption of Technological Determinacy 403

1. Some general patterns 403

2. Is the technology more determinate, and if so, what are the consequences? 408

3. Mapping and optimisation: the potential and limits of social science 411

Appendix Table 2.1 Output variables used in production functions 415

Appendix Table 2.2 Explanatory variables used in the modelling 419

Appendix 26.1 Commissioning Responses to Relative Prices and Costs of In-House and Independent Provision 425

1. Theoretical logic 425

2. Data 426

3. Results 427

3.1. Price differences and changes in price differences between FY1996 and FY1997 427

3.2. Intersectoral quantities demanded FY1996 and FY1997 428

3.3. Relationship between price gaps and changes in purchasing 429.

Notes:

Published in association with Personal Social Services Research Unit.

Includes bibliographical references and index.

ISBN:

0754612813

OCLC:

43580881