Thursday, August 27, 2009

[EQ] Analysing the costs and benefits of social care funding arrangements in England

Analysing the costs and benefits of social care funding arrangements in England:
technical report

 

Julien Forder and José-Luis Fernández

PSSRU Discussion Paper 2644 July 2009

PSSRU Personal Social Services Research Unit.

PSSRU branchs:University of Kent at Canterbury; London School of Economics and Political Science (LSE) and at the University of Manchester.

 

Available online PDF [55p.] at: http://www.pssru.ac.uk/pdf/dp2644.pdf

 

“…..The funding of long-term care is highly complex and involves a range of different funding sources and funding organisations. It is quite common for a person’s care needs to be simultaneously supported by funds from local councils, the benefits system, and their own income and savings. At present, public financial support is mostly subject to a detailed and complicated financial means-test, that assesses in depth applicants own financial situation.

 

Once broad eligibility for financial support is determined, the amount of funding support that a person receives depends largely on the intensity and cost of the support they are assessed as needing. The latter is established after a detailed needs assessment. Moreover, the type of care that a person uses also affects the nature and level of funding support. There are at present, for example, separate funding rules for residential and non-residential care. The upshot is that overall older people end up paying a significant proportion – around a half – of total expenditure on social care out of pocket.

 

Funding social care services is likely to become more difficult in to the future. Underlying demand for care is set to rise significantly as a result of the ageing population and trends in chronic diseases. The price per unit of care service has been and is likely to continue to rise faster than general inflation. Although there is perhaps scope to improve the use of resources, the pressure to find more money looks to be significant. These resources will need to be raised from public funds, from the pockets of individuals and their families, or both…..

 

This report outlines the analytical work that was commissioned by the Department of Health to feed into the development of a Green Paper. It describes the methods and assumptions underlying the model used for analysing long-term funding systems.

 

The paper gives details of potential and actual users of care, their levels of need, and their income and assets. It details the system of support available, the current funding arrangements and the benefits system. The report looks at costs and to the degree to which population need is being met. It concludes with an assessment of the current system.

 

Three considerations are particularly salient when assessing the case for reforming the funding of long-term care.
First, how does the reform affect the benefits or outcomes of the system for its stakeholders (e.g. service users, informal carers, service providers)?
Second, what are its costs implications – for the public purse and for individuals?
Third, what is the distribution of these costs and benefits across the population? In other words, who stands to gain and who to lose from any changes?

 

The goal of the analysis is for these three considerations to be made in specific, quantifiable terms so that the size of changes can be assessed. This means not only determining the change in costs but also (and as far as possible) the changes in outcome. Importantly, these changes ought to be assessable at the individual person level as well as in aggregate terms, in order to assess the distributional effects of any reform….”

 

 

Contents

1 Introduction

2 The PSSRU micro-simulation model

3 Characteristics of the population

4 Model outputs: derived variables

5 The needs test and the care ‘offer’

6 Behavioural assumptions

7 Unmet need

8 Applying funding arrangements

9 Assessing the current system

9.1 Distribution of net payout at the point of need and distribution of charges

9.2 Distribution of unmet need

9.3 Distribution of spend-down

9.4 Reforming AA

10 Concluding points

11 References

12 Notes

 


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This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate

information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic

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“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings

and interpretations included in the Materials are those of the authors and not necessarily of The Pan American

Health Organization PAHO/WHO or its country members”.
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[EQ] Policies for Orphan Diseases and Orphan Drugs

Policies for Orphan Diseases and Orphan Drugs


ALAIN DENIS, STEVEN SIMOENS, CHRISTEL FOSTIER, LUT MERGAERT, IRINA CLEEMPUT

Federaal Kenniscentrum voor de Gezondheidszorg Centre fédéral d’expertise des soins de santé

The Belgian Health Care Knowledge Centre – 2009

KCE reports 112C - Health Technology Assessment (HTA)

Available online PDF [132p.] at: http://www.kce.fgov.be/Download.aspx?ID=1664

“….Due to low prevalence, rare diseases have traditionally been neglected by industry and by the scientific, medical and political communities. It is estimated that there are currently between 5000 and 7000 different rare or orphan diseases. Both in the United States (US) and in the European Union (EU), schemes were launched to stimulate the development of ‘orphan drugs’, drugs developed to treat these orphan diseases.

 

The rationale behind these legislations is to compensate industry for the risks and lower potential return on investment as a consequence of the inherently low number of patients. These schemes are considered as a success with an increasing number of Orphan Designation requests filed at the US Food and Drug Administration (FDA) and the European Medicines Agency (EMEA).

 

This study’s objectives are to:

1. provide an overview of the commonly used definitions for ‘orphan diseases’ and ‘orphan drugs’ and describe the particularities of orphan drugs as compared to drugs for regular diseases;

2. describe the regulatory processes for orphan drugs from Orphan Designation to reimbursement;

3. compare the Belgian orphan drug reimbursement policy with other countries;
4. estimate the current budget impact of orphan drugs and forecast the expected future budget impact;

5. formulate recommendations for policy makers concerning orphan drugs….”

 

Table of contents

 

1 Introduction

2 Orphan, Rare and Neglected Diseases and Drugs: definitions and particularities

3 Policy Description

4 International comparison of orphan disease and drug markets in Europe

5 Critical Assessment

5.1 introduction

5.2 methodology

5.2.1 Qualitative overview

5.2.2 In-depth analysis

5.3 qualitative overview of all reimbursement dossiers

5.4 in-depth analysis of 15 selected reimbursement dossiers

5.4.1 Comparison of the evaluations by EMEA

5.4.2 Comparison of the studies mentioned in the NIHDI file, the EMEA file and EPAR

6 Budget impact analysis

7 Discussion and conclusions

7.1 orphan drug designation as a tactical step

7.2 prevalence versus economic motives

7.3 assessing clinical added value

7.4 the need for a right balance between ethical and economic concerns

7.5 pricing

7.6 extension of indications

7.7 growth of the budget impact of orphan drugs

7.8 variations in access and use among member states

7.9 awareness raising

7.10 colleges and control of eligibility

7.11 use of registries

8  Appendices

 


*      *      *     *
This message from the Pan American Health Organization, PAHO/WHO, is part of an effort to disseminate

information Related to: Equity; Health inequality; Socioeconomic inequality in health; Socioeconomic

health differentials; Gender; Violence; Poverty; Health Economics; Health Legislation; Ethnicity; Ethics;

Information Technology - Virtual libraries; Research & Science issues.  [DD/ KMC Area]

“Materials provided in this electronic list are provided "as is". Unless expressly stated otherwise, the findings

and interpretations included in the Materials are those of the authors and not necessarily of The Pan American

Health Organization PAHO/WHO or its country members”.
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PAHO/WHO website: http://66.101.212.219/equity/

Equity List - Archives - Join/remove: http://listserv.paho.org/Archives/equidad.html
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    IMPORTANT: This transmission is for use by the intended recipient and it may contain privileged, proprietary or confidential information. If you are not the intended recipient or a person responsible for delivering this transmission to the intended recipient, you may not disclose, copy or distribute this transmission or take any action in reliance on it. If you received this transmission in error, please notify us immediately by email to infosec@paho.org, and please dispose of and delete this transmission. Thank you.