Labour has given new direction and energy to the community care reforms, including an elaborate, integrated and potentially powerful system amounting to equity and efficiency policy. Its content is more defensible the greater the degree of 'technological determinacy' of the new community care, and the better understood are those relations between service means and ends valued by policy-makers. The paper describes the relations between service inputs and outcomes, patterns of variations in efficiency, and consequences of successful investment strategies to make the performance of the less efficient like that of the most efficient. It shows the implications for the content of equity and efficiency policy under alternative scenarios. Evidence is for triads of 419 new users, their caregivers and care managers, including depth interviews at the end of the set-up stage of the case-managed process and six months later, continuous tracking of broad needs and service utilisation. Methods of analysis include estimation of production functions using Tobit, OLS, and 3SLSL modelling, and optimisation analysis assuming various scenarios, showing the effects on service utilisation and outcomes for various user subgroups given the choices of outputs to be maximised and the 'collateral' consequences for other outputs. Results suggest greater 'technological determinacy' than pre-reform, with 70 substantial productivity effects, but variations in efficiency. The discussion illustrates how this new type of analysis contributes to handling current policy issues.
Learning Objectives: At the conclusion, the participant will have grasped - the concepts of production function analysis and optimisations based on them, - the nature of British equity and efficiency policy in community care, - aspects of British performance in community care Participants will be able to think through the possible application of the approach in American contexts
Keywords: Policy/Policy Development, Home Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.