Costs Of Community Services Research Articles

The Fiscal Impacts of Alternative Land Uses

Current knowledge of the fiscal impacts of alternative land uses comes largely from cost of community services (CCS) case studies, the results of which are viewed skeptically in the literature due to methodological concerns. To address these issues, we develop an econometric approach that allows us to capture both the direct and indirect relationships between a complete accounting of community fiscal measures and the full distribution of acres of land uses in a jurisdiction. Using a novel panel data set, we extensively document empirical correlations that have not yet been formally established in the literature. Our results are inconsistent with the broad conclusions of CCS studies: neither a shift from agricultural to residential land nor a shift to commercial land is associated with a significant change in the budget. We provide support for and insights into our results by extending our analysis to finer revenue/expenditure and land-use subcategories.

The Fiscal Impacts of Alternative Land Uses: An Empirical Investigation of Cost of Community Services Studies

Current knowledge of the fiscal impacts of alternative land uses comes largely from cost of community services (CCS) case studies, the results of which are viewed skeptically in the literature because of numerous methodological concerns. In order to begin to fill the gap in our understanding of these impacts, we provide the first empirical estimates of the relationship between a complete accounting of community fiscal measures and the full distribution of acres of land uses in the jurisdiction. We find evidence in support of the broad conclusions of CCS studies: a shift from agricultural to residential land is associated with a deficit, whereas a shift to commercial land is correlated with a surplus. We provide insights into which revenue/expenditure and land use subcategories are responsible for these results.

The Woodwork Effect in Medicaid Long-Term Services and Supports

This paper examines annual real per capita Medicaid long-term services and supports (LTSS) expenditures (in 2010 $) over the period 1995 to 2010. Medicaid community LTSS expenditures increased substantially. If that trend constituted a woodwork effect, expenditures on institutional services should have declined more slowly than community expenditures increased, resulting in total expenditures increasing over time. Such a woodwork effect is observed for the population with intellectual and developmental disabilities (IDD) but not for the non-IDD population, composed of persons with disabilities other than IDD, including older persons. During this time period, the goals for serving people with IDD changed; institutional and community cost-neutrality rules were relaxed (and with that concerns over a woodwork effect), and instead goals of community involvement and participation were emphasized for all eligible persons. For the non-IDD population, tighter adherence to cost-neutrality rules and controls over nursing home reimbursements may have helped avoid a woodwork effect as community expenditures increased. With the passage of the Americans with Disabilities Act in 1990, goals have changed for people with disabilities of all ages, and the notion of a simple trade-off between institutional and community service costs that constitutes the woodwork effect must be complemented with a much broader idea of cost analysis that values independence and community participation for people with disabilities of all ages.

A specialist led community based subcutaneous diuretic service for end stage heart failure

IntroductionMultiple hospital admissions are a common feature of advanced heart failure(HF), accounting for significant healthcare expenditure. Admissions are often precipitated by increasing breathlessness, and inpatient intravenous diuretics are administered. Collaboration...

Cost‐effectiveness of gastrostomy placement for children with neurodevelopmental disability

. Craig G., Lawson M., Reilly S. & Spitz L. ( 2008 ) , 93 , 873 – 877 . Introduction Malnutrition and growth deficiency are common in neurologically impaired children. Gastrostomy placement has been shown to result in significant catch‐up growth, improved health of the child and reduction in family stress; its cost‐effectiveness has not been investigated.Aims Costs related to gastrostomy placement are estimated here from a prospective controlled study of children referred to a tertiary paediatric centre in the UK.Methods Costs of inpatient stay, medication, tests, general practitioner consultations, community health care, equipment and parents' indirect costs were estimated at baseline and follow‐up. Costs of the different types of gastrostomy surgery are given.Results Results for both time periods were available for 54 of the 76 children recruited to the study. Five‐day food diaries were kept at baseline and follow‐up. Costs of food increased slightly but not significantly post surgery from £33 to £40 (€44 to €54, US$65 to US$78) per week. Variation in cost between cases was considerable, but the mean net cost difference of £20.80 (CI £−43.79 to £85.35) [€28 (CI €−59 to €115), US$41 (CI US$−86 to US$167)] per week per child including for food and surgery was also not significant. Community service costs were significantly lower post surgery. Few parents reported personal costs at either time point, although many had reduced or stopped paid work to care for the child.Conclusion As gastrostomy placement for these children resulted in significant clinical benefit at no significant extra cost, it is concluded that the procedure is cost‐effective.

Why are psychiatric services getting better but looking worse

Why are psychiatric services getting better but looking worse

Cost-effectiveness of gastrostomy placement for children with neurodevelopmental disability

Introduction: Malnutrition and growth deficiency are common in neurologically impaired children. Gastrostomy placement has been shown to result in significant catch-up growth, improved health of the child and reduction in...

An Innovative Approach to Cost of Community Service Studies in Wisconsin

Cost of Community Services (COCS) studies attempt to explain whether or not different types of land uses generate more (or less) revenue than they consume in public services. The technique, developed by the American Farmland Trust (AFT), uses detailed information about how much revenue is generated from each particular type of land use, and then allocates all local government spending to the various land use categories. The results provide a community with a set of ratios of the net fiscal impact of various land use types at a given point in time. AFT has facilitated a series of COCS studies across the nation; in recent years, local governments and other researchers have been collecting COCS data on their own. However, conventional COCS studies have been discounted due to a number of criticisms. To address these criticisms, an innovative COCS methodology was employed for three towns in Dane County, Wisconsin. This paper summarizes the results of the study and details the methods employed, which deviate from the standard methods put forth by the American Farmland Trust in several important ways. Most notably, in this study, farm residences are separated from nonfarm residences to enable us to compare COCS ratios for different types of residences and to allow us to combine the revenue and expenditure information for both farmland and agricultural residences into a single indicator for farming operations. This provides a better picture of the total fiscal impact of farms and their residents and workers on a community than does the conventional AFT approach. The implications of this approach are discussed.

Demographic and socio-economic determinants of community and hospital services costs for people with HIV/AIDS in London

We examined the influence of demographic, social and economic background of people with HIV/AIDS in London on total community and hospital services costs. This was a retrospective study of community and hospital service use, needs and costs based on structured questionnaires administered by trained interviewers and costing information obtained from the service purchasers and providers, based on two Genito-urinary Medicine clinics in London: the Jefferiss Wing at St. Mary's Hospital and Patric Clements at the Central Middlesex Hospital, London, England. The subjects were 225 HIV infected patients (105 asymptomatic, 59 symptomatic non-AIDS and 61 AIDS). We found that over and above well established determinants of health care costs for HIV infected people such as disease stage and transmission category, social and economic factors such as employment and support of a living-in partner significantly reduced community services costs. Private health insurance had a similar effect, though only a small proportion of HIV people had such cover. The cost of community services for HIV infected non-European Union nationals, mainly of African origin, was one quarter that for the European Union nationals. Community services costs were highest for heterosexually infected women and lowest for heterosexually infected men after adjusting for other factors. Hospital services costs were significantly higher for HIV infected people lacking educational qualifications and employment. We conclude that access to community care for HIV infected non-EU nationals appears to be very poor as the cost of their community services was one quarter that for the EU nationals after adjusting for the effects of transmission category, disease stage, living with a partner, employment and having a private health insurance. Additional incentives for informal care for HIV infected people could be a cost-effective way to improve their community health service provisions.

RURAL DISADVANTAGE IN THE DISTRIBUTION OF SOUTH AUSTRALIAN HOME AND COMMUNITY CARE FUNDING

In this paper, the level of HACC funding under the South Australian Dementia Support and Respite Projects and the Community Support Scheme was compared across Domiciliary Care and Human Services and Health regions. Results revealed that metropolitan regions generally received more than their per capita share of HACC funding despite the greater cost of community services in rural areas and the relative paucity of supplementary or alternative rural services. The need for greater planning in the distribution of HACC funds, including moving towards formula funding is identified.

Health care costs of people referred to an aged care assessment team: the effect of cognitive impairment.

The aim of this study was to determine the effect cognitive impairment has on direct and indirect costs to elderly people, their carers and the community over one year, by following prospectively a cohort of elderly people referred to an aged care assessment team. The 78 subjects were drawn from a random sample of people referred to the NorthWest Hospital team, and validated tools were used to assess their cognitive state. Outcome measures included total costs of community services, residential care, hospital bed use, carer burden and psychological morbidity. A comparison of outcome measures was made between those with cognitive impairment and those without. Use of community services and hospital beds was high overall. Those with cognitive impairment were substantially greater users of residential care, accounting for the higher expenditure in this group. Psychological morbidity and burden remain high in carers of those with cognitive impairment despite a high rate of institutionalisation in this group. The total costs for those referred to aged care assessment teams with cognitive impairment are double those seen for those with normal cognition.

Determining the size of a total purchasing site to manage the financial risks of rare costly referrals: computer simulation model.

To estimate the financial risks of 15 categories of rare costly referrals for total purchasing sites of different population sizes. Computer simulation of 100 fund years assuming Poisson distribution of referrals. British general practices that have opted to become total purchasing sites. Referral rates and price estimates were supplied by South and West Devon Health Commission. Variation in referral costs to purchasers in relation to size of risk pool (person years at risk). Random variation in referral costs increased as the size of the risk pool decreased. Variation increased greatly below 30,000 person years. The mean simulated cost of the referral categories considered was 2.8% of total NHS hospital and community service costs, and the maximum simulated cost for 7000 person years was 6.8%. Simulated variation was robust to assumption about prices and referral rates for specific types of referral. Rare costly referrals seem unlikely to bankrupt total purchasing sites. The management of risk is not in itself justification for total purchasing to be based in several general practices in order to generate large populations. There are other ways of managing risk. Sites can easily explore options by simulations using local referral rates and prices.

The Comparative Costs of Community Service and Custody in Scotland

Abstract: This paper examines the costs of community service orders, and compares them with the costs of alternative custodial sentences. Twelve Scottish community service schemes are studied. Costs are disaggregated to component activities (assessment, matching, placement supervision and breaches), and average costs per offender calculated and compared. It is found that, while cheaper than custody, community service is not as cheap as recent central government figures suggest. On average, community service costs the same as about six weeks of custody. The implications for cost of changes to the organisation, funding and utilisation of community service orders are discussed.

Cost-Effectiveness of Clozapine for Treatment-Resistant Schizophrenic Patients

Clozapine therapy for treatment-resistant schizophrenic patients resulted in decreases in psychopathology and reductions in mental health service costs. The majority of these savings were due to reduced use of inpatient hospital services. Reduction of the need for hospital services improves the quality of life of this group of chronic patients, as long as necessary aftercare services are available. An additional advantage of clozapine is the increased clinical contact that results from frequent monitoring for possible hematologic effects. This contact may contribute to a more appropriate level of care for schizophrenic patients in a community setting. Although community service costs for these patients might increase, improved quality of care and early intervention in the event of an acute schizophrenic episode may result in improved patient functioning and decreased total costs. Economic benefits were observed after two years of clozapine therapy. If these findings are generalizable beyond two years, clo...

Minimizing the Cost of Community Services

AbstractThe linear programming transportation model is suggested as a useful planning tool in minimizing the cost of community services. Based on the assumption that economies of scale exist in providing community services, a consolidated district or regionalization approach is suggested. Specifically, regional systems for two community services—education and solid waste disposal—are considered for two regions in New Hampshire. Although the type of data required, solution procedures, and results are discussed, the major emphasis is placed on application of the research technique. Further, the importance of precise cost information and cost allocating procedures is discussed. Finally, the problems associated with adoption of a regional solution that minimizes the cost of community services are discussed in terms of the social-politics of location.