Integration, funding and resource flows in the care system - Projects


1. The economics of integration: understanding the consequences of alternative health and social care integration arrangements

 

Project lead: Jose-Luis Fernandez

Context and problem statement

Across England, the policy emphasis on improving integration across the care system is leading local authorities and Clinical Commissioning Groups (CCGs) to put in place new “joint” arrangements for assessing care needs, designing care packages and commissioning services.

Project aims

The aim of the project is to shed light on the different local arrangements for integration, and to use this evidence to explore the link between alternative local integrated assessment, commissioning and delivery processes and key indicators of local care system performance.

 

2. Interdependency and coordination of health and care services: using economic methods to define target groups and care pathways

 

Project lead: Andrew Street

Context and problem statement

Policy makers have long promoted ‘integrated care’ for people with complex needs, hoping to save money and improve health outcomes. We seek to assess which groups of the population would most benefit from improved integration, the nature of the health and social care packages that people receive, and the degree of substitution or complementarity between elements of their care packages.

Project aims

The project has the following objectives

  1. To quantify the potential for cost savings in the allocation of resources by identifying which groups of the population to target
  2. To estimate the size of integrated health and social care budgets for people with particular co-morbidity profiles.
  3. To identify which clients/population are associated with utilisation of services from multiple agencies.
  4. To estimate the degree of substitutability and complementarity between services for those populations.
  5. To estimate the size of transaction costs associated with separate and joint working for different populations.
  6. To quantify the cost implications on budget holders and providers of changes in the care pathway.

3. Assessing the consequences of budget changes on the care system and self-funders

 

Project lead: Jose-Luis Fernandez

Context and problem statement

Given the nature of public funding of social care, it is important to understand the implications of changes in public budgets for care on the patterns of service utilisation by local authorities, and to help develop possible strategies to best achieve equity and efficiency goals in that context. This project is designed to provide guidance to funders and commissioners as to how to deploy scarce public funds for social care.

 

Project aims

 

The proposed study aims to understand how different authorities manage resources given budgets and how they react to changes in budget:

4. Analysis of the impact of local authorities’ new responsibilities to support carers

 

Project lead:Julien Forder

Context and problem statement

Unpaid care by family and friends is at the heart of the care system. Carers provide the majority of care and support in England, with potential impacts on their own quality of life, health and employment. Under the provisions of the Care Act 2014, local authorities assumed from April 2015 expanded responsibilities to assess the needs of carers and provide support to them in their own right. It is important to understand the impact that carer’s can have on the use of (formal) service, and how therefore improved support for carer’s might have the potential to reduce pressure on formal services.

Project aims

The aim of the project is to explore the following:

5. Health care expenditures, proximity to death and changes over time

 

Project lead: Nigel Rice

 

Context and problem statement

 

This project aims to explore and explain the rise in health care expenditures observed in England over time.  We will document the ways in which expenditures have grown over time at an aggregate level for hospital services (inpatient, outpatient, A&E) and GP prescribing together with potential correlates, focusing on population growth and ageing, GDP and mortality rates. 

Project aims

To further understand the drivers of health care expenditures the project has the following aims:

  1. To document basic trends in health care expenditure over time at an aggregate level, including expenditure per capita and as a percentage of GDP, with a particular focus on Hospital and Community Health Services (HCHS), but also including GP prescribing and Family Health Services.
  2. To explore changes in expenditure over time, by decomposing expenditure into components due to changing morbidity profiles (changing patterns of morbidity) and due to changes in the impact of such conditions on expenditure (how treatment costs have changed over time).
  3. To explore the dynamics of health care expenditures.  What are the characteristics of individuals who persistently access health care over time?
  4. To explore these issues with a focus on expenditure in proximity to death.

6. Projecting future levels of social care clients and expenditure in England


Project lead: Raphael Wittenberg

Context and problem statement

The continuing rise in the number of older people and people with learning disabilities, together with uncertainty about the future supply of unpaid care, have led to concern about the sustainability of public expenditure on care. 

Project aims

The aim of this work is to produce robust projections of future demand for long- term care for older people and younger adults and associated public expenditure, under a range of assumptions and scenarios about future mortality and disability rates, future policy on the living wage, future availability of unpaid care, future policy on the balance of care, and potential funding reforms.