Cost-benefit analysis of functional adaptation at home for reducing assistance needs and preventing falls: The case of Barcelona
Estefania Alaminos | Riskcenter-Universitat de Barcelona
Objective: To provide an economic assessment of a public programme aimed at providing support products and perform works at home for a sample of people over 65 years living in the city of Barcelona in 2013. A cost-benefit analysis of the program has been carried out taking into account not only the expected reduction in care needs, but also the reduction in the expected number of falls/accidents at home.
Data and methods: We work with a sample of 454 people aged 65 or older who have limitations to perform daily tasks without support, 55% receive public long-term care benefits, 75% are women and 25% are men. The most frequent age group is 80 to 89 years. They are individuals who mostly live alone but receive care from third parties to perform basic daily activities. Two types of actions are considered: a) providing technical support products (82% of cases); b) performing works in the house (18% of cases). An indicator of self-perception of the need of care (IAPD) is created based on the subjective assessment on their limitations to perform basic activities of daily life. The scores are analysed before and after the intervention and the economic consequences are calculated.
Results: Men have a higher value of IAPD before and after interventions than women. In both cases, a reduction in the need for care is observed but a larger reduction is observed for women (the percentage of reduction is 33.5% for men and 35.81% for women). The reduction in the IAPD indicator is about 36.70% for those in the age group between 65 and 79 years, 38.46% for the group 80 to 84 years, 33.80% for the age group 85 to 89 years, and 31.55% for people aged 90 or more years. Works at home result in a higher reduction (45%) than the provision of technical support products (33%). In economic terms, for every euro invested in technical products, the annual savings range between 2.74 and 3.71 euros, taking into account lower requirements for third party support and prevention of different types of falls. The repayment of the investment is less than 5 months. In the case of works at home, the yield ranges from 5 to 6.35 euros, with a maximum repayment term of 1 year. Performance is positive in all scenarios analysed.
Policy implications: The cost-benefit analysis conducted confirms the efficiency of preventive policies. Governments should increase budget allocations aimed at this type of action taking into account the high yields and the expected effect on the quality of life and long-term care needs.
Acknowledgements: This study was supported by ICREA Academy, the Spanish Ministry of Economy and Competitiveness and the ERDF grants ECO2013-48326-C2-1-P and ECO2015-66314-R.