Future research agenda: making the economic case for investing in support for growing older with disabilities David McDaid

LSE Health & Social Care & European Observatory on Health Systems and Policies, London School of Economics

Growing Older With A Disability Conference, Festival of International Conferences on Caregiving, Disability, Ageing and Technology (FICCDAT)June 2011

d.mcdaid@lse.ac.uk

Structure

Why should we be interested in economics?

Making use of economics in the research agenda on GOWD

Some examples of how economics has been used

Moving forward

Why should we be interested in economics?

Economics is just about choice?

Budget

Supporting peopleGOWD

Support for childrenwith intellectual

difficulties

Just about economic evaluation?

The effectiveness question:

Does this intervention work?

The economic question:Is it worth it?

Two Basic Needs: (A) Costs and Outcomes; (B) 2+ Alternatives

Outcomes (e.g. Quality of Life Years (QALYs) for intervention X

Costs for intervention X; Impact on other costs

Costs for intervention Z; Impact on other costs

Outcomes (e.g Quality of Life Years (QALYs) for intervention Z

http://www.jrf.org.uk/publications/because-its-worth-it-practical-guide-conducting-economic-evaluations-social-welfare-fie

Many questions that economic research can address?

• The costs of inaction: What are the economic consequences of not supporting GOWD?

• The costs of action: What would it cost to intervene by providing a supportive measure ?

• The cost-effectiveness of action: What is the balance between what it costs to intervene and what would be achieved in terms of better outcomes, e.g. health status, improved functioning, independence, inclusion, quality of life, employment status?

• The levers for change: What economic incentives can encourage more use of those interventions that are thought to be cost-effective and less use of those interventions which are not?

Important to make economic case

Policymakers interested in cost impact as well as effectiveness

Do improvements in outcomes justify investment?

But can be improved outcomes for greater investment

Make case across sectors: impacts fall on many sectors, not just health / social welfare

What do we know about the economic costs and benefits of GOWD?

Costs and benefits of GOWD

Many studies looking at the costs of living with disability

Many studies looking at the costs of old age

Limited studies looking specifically at the interface between the two

Little focus on ‘benefit’, predominantly about cost

Health System Costs of Osteoarthritis of the Knee in Italy

Drugs7%

Devices5%

Hospitalisation25%

Transport5%

Paid Carers27%

Physiotherapy9%

Diagnostics22%

Leardini et al Clin Exp Rheumatol 2004

€934 per patientper year

Total Costs of Osteoarthritis of the Knee in Italy

Other carers3%

Lost Employment

18%

Informal Primary Carer

35%

Health system44%

Total cost = €2170 per patient per year

Leardini et al Clin Exp Rheumatol 2004

Employment, unemployment and inactivity among people with disabilitiesAPPLICA & CESEP & EUROPEAN CENTRE 2007

Disability Benefits GB 200722%

40%

6%8%

18%

6%

Other Mental and Behavioural Disorders

Nervous System Circulatory and Respiratory System

Musculoskeletal System Injury, Poisoning, External Causes

Source: Department of Work and Pensions, 2007

€ 3.9 billion per annum

Plus reduced tax receipts €14 billion

Projecting economic costs of disability and ageing MAP2030

http://www2.lse.ac.uk/LSEHealthAndSocialCare/MAP2030/

Projecting economic costs of disability and ageing MAP2030

http://www2.lse.ac.uk/LSEHealthAndSocialCare/MAP2030/

Projecting economic costs of disability and ageing MAP2030

http://www2.lse.ac.uk/LSEHealthAndSocialCare/MAP2030/

But….a need to know more about the positive social, emotional and economic benefits of postive ageing and disability

Economic Benefits of ‘Made in Manitoba’ Legislation

http://www.gov.mb.ca/dio/discussionpaper/pdf/discussionpaper.pdf

Economic benefits of Disability Access Legislation Highlighted

Economic Benefits of ‘Made in Manitoba’ Legislation

Loyal, capable workforce

Hiring and accommodating older workers and persons with disabilities to help in challenge of retaining skilled workers

Increased incomes, increased tax revenues; reduced need for public support

$1 billion per annum in consumer spending power.

Eliminating barriers to employment / consumer services will expand figures and boost contribution of consumers to economy.

Market for products for people with disabilities substantial – often goes beyond people with disabilities

• Report for European Commission, DG Information and Society

• Looking at potential scope for action

• Including economic impact

Kevin Cullen, Lutz Kubitschke, David Mc Daid, Peter Blanck, William N Myhill, Gerard Quinn, Patrick O Donoghue and Rune Halverson, 2008,

Making the economic case for the accessibility of ICT products and services to disabled and older people

Valuing the socio-economic contribution of older people in the UK (2011)

• In 2010 positive net contribution to UK economy £40 billion rising to £77 billion by 2030.

• Costs: takes account of pension, welfare, health costs.

• Benefits: Tax revenues, Consumer Spending, Provision of Care, Volunteering

http://www.goldagepensioners.com/Uploads/PDF/main-report.pdf

Valuing the socio-economic contribution of older people in the UK (2011)

http://www.goldagepensioners.com/Uploads/PDF/main-report.pdf

Economic value of benefits

http://www.goldagepensioners.com/Uploads/PDF/economic-model-report.pdf

Approach could be

replicated in other settings;

adapted to specific

population sub-groups

http://www.myspace.com/kirkdouglas

A need to know more about economics and positive wellbeing for GOWD

The economic benefits of wellbeing

• Traditional focus on tackling disease.

• Health assumed to be ‘absence of illness’

• Wellbeing goes beyond absence of illness

• Issues around mental and physical capital, social cohesiveness; altruism; innovation

• All of this has potential economic benefits

Wellbeing and satisfaction with life

To sum up

Economics can help make case for investment in support for GOWD

Research on costs of ageing/costs of disability, but less on interface or specific population groups

Opportunities for research consideration of business case/case to public purse of GOWD more positively

Opportunities to look at economic benefits of better wellbeing

Opportunities for collaboration with economists