What explains regional variation in privately provided out-of-area residential placement costs for people with intellectual disability in Ireland?

IF 2.1 2区 医学 Q1 EDUCATION, SPECIAL
J. Cullinan, T. O'Brien, E. Yacoub
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引用次数: 0

Abstract

Background

Expenditure on residential placements for people with intellectual disability (ID) in Ireland is considerable and expected to increase. Despite this, there is limited evidence on the factors driving variation in privately provided ‘out-of-area’ residential placement costs, including across Community Health Organisations (CHOs)/regions. This is important to help inform the delivery of services at best value.

Methods

We analyse unit cost data from 2019 for a sample of 278 high-cost publicly funded privately provided out-of-area residential placements for people with ID in Ireland. We undertake univariate analysis of the relationship between costs and a wide range of variables using t-tests and one-way analysis of variance. We employ multivariable regression analysis to examine how raw differentials in unit costs across regions can be accounted for by individual-level characteristics.

Results

We estimate average unit costs of €264 170 per annum in our sample. The univariate analysis shows considerable variation in costs across a range of personal, disability, psychiatry/psychological, forensic issues, behaviour and supports and plans related variables. We also find wide variation in average unit costs across CHOs/regions (F = 4.58, P < 0.001), ranging from €213 380 to €331 880. The multivariable analysis shows that regional differences remain even after accounting for a wide range of individual characteristics that influence costs.

Conclusions

Our analysis shows that while the majority of differences in costs across regions can be explained, there is potential for cost savings in the provision of high-cost publicly funded out-of-area residential placements in Ireland. Overall this can help to develop and implement a more sustainable disability residential funding model in a context of rising demand for services. It also has potential implications for the approach to procurement of services.

Abstract Image

爱尔兰智障人士在地区外私人提供的寄宿安置费用存在地区差异的原因是什么?
背景:在爱尔兰,智障人士的住宿安置费用相当可观,而且预计还会增加。尽管如此,有关私人提供的 "地区外 "住宿安置费用差异的因素(包括社区医疗机构(CHO)/地区之间的差异)的证据却很有限。这对于以最佳价值提供服务非常重要:我们分析了2019年爱尔兰278个高成本公共资助私人提供的地区外智障人士寄宿安置样本的单位成本数据。我们使用 t 检验和单向方差分析对成本与各种变量之间的关系进行了单变量分析。我们采用多变量回归分析,研究不同地区单位成本的原始差异如何通过个人层面的特征来解释:我们估计样本的平均单位成本为每年 264 170 欧元。单变量分析表明,在一系列与个人、残疾、精神病学/心理学、法医问题、行为和支持以及计划相关的变量中,成本差异相当大。我们还发现,不同护理组织/地区的平均单位成本差异很大(F = 4.58,P 结论):我们的分析表明,虽然不同地区之间的大部分成本差异都可以解释,但在爱尔兰,提供高成本的公共资助地区外寄宿安置仍有可能节约成本。总体而言,这有助于在服务需求不断增长的背景下,制定并实施更具可持续性的残疾人寄宿资助模式。它还可能对服务采购方法产生影响。
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来源期刊
CiteScore
5.60
自引率
5.60%
发文量
81
期刊介绍: The Journal of Intellectual Disability Research is devoted exclusively to the scientific study of intellectual disability and publishes papers reporting original observations in this field. The subject matter is broad and includes, but is not restricted to, findings from biological, educational, genetic, medical, psychiatric, psychological and sociological studies, and ethical, philosophical, and legal contributions that increase knowledge on the treatment and prevention of intellectual disability and of associated impairments and disabilities, and/or inform public policy and practice. Expert reviews on themes in which recent research has produced notable advances will be included. Such reviews will normally be by invitation.
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