Economics and new strategies for funding and financing

Introduction: Decision makers in care and support systems across Europe are increasingly facing up to new economic realities. Most obvious among the forces that are changing the economic context is the ageing of the population, and the associated realisation that today’s arrangements for supporting older people with health and social care needs will probably not be seen as affordable in 20 or 30 years time. Another force for change is that many more people with major disabilities are surviving into old age. At the same time, and a further cause for celebration, older and disabled people today have different expectations, in particular demanding access to the same opportunities as those available to any other citizen. This manifests itself in, for example, higher aspirations for participation in further and higher education, for employment, for relationships and family roles, and for control over decisions that affect their daily lives. Description and discussion: Set in this exciting new context, the aim of this presentation will be to identify the new economic challenges that pervade the fields of ageing and disability, and describe some possible responses, in particular looking to learn from across the broad spectrum of ageing and disability. Among the areas to be considered are: the funding of long-term care and support, and the need to consider radical new arrangements; the promotion of choice and control; the development of inclusive employment strategies; the conceptualisation and assessment of success (‘outcome’) in research; and the creation of an evidence base to support decision-making. In each case, the focus will be on the contributions made by economic insights and analysis

Análisis Coste-beneflcio del Programa de Detección Precoz de Enfermedades Metabólicas en la Comunidad Autónoma Vasca

ResumenSe estudia la rentabilidad social del Programa de Detección Precoz y Tratamiento de dos enfermedades metabólicas, la fenilcetonuria y el hipotiroidismo congènito, en la Comunidad Autónoma Vasca, en vigor desde noviembre de 1982.La técnica utilizada es el análisis coste-beneficio. Los costes sociales de detección y tratamiento se comparan con los beneficios sociales de la prevención del retardo mental (1984 y 1985). Los Índices beneficio-coste (BC) y el valor actual neto (VAN) muestran que el programa es rentable excepto cuando los valores futuros de costes y beneficios son descontados a tasas elevadas. Los resultados del estudio son consistentes con los obtenidos por otras evaluaciones económicas de este tipo de programas.En términos de coste-efectividad, el coste de prevenir un caso de subnormalidad se estimó en 3.300.000 ptas., lo que podría interpretarse como un limite inferior a la valoración social de la prevención de la deficiencia mental.SummaryThe efficiency of an early screening and treatment Programme for two Metabolic disorders, phenylketonuria and congenita! hypothyroidism running since November 1982 in the Basque Country, is analysed.The cost-benelit analysis technique is used. The social costs of screening and treatment are compared with the social benefits for the prevention of mental handicap (1984-1985). Benefit-cost ratios and the net present value shows the social efficiency of the programme except when high discount rates have been used for discounting future costs and benefits. That conclusion is consistent with the results of other cost-benefit studies.In terms of cost-effectiveness the cost per child with mental handicap prevented was estimated on 3.300.000 ptas. That could be seen as the lowest social value for the prevention of a child with mental handicap