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Health care and social welfare costs in home-based and hospital-based rehabilitation after stroke
Linköping University, Department of Medicine and Health Sciences. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, Health Technology Assessment. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medicine and Health Sciences, Physiotherapy. Linköping University, Faculty of Health Sciences.
2002 (English)In: Scandinavian Journal of Caring Sciences, Vol. 16, no 4, 386-392 p.Article in journal (Refereed) Published
Abstract [en]

During the 1990s most western European and Organization of Economic Cooperation and Development (OECD) countries experienced financial difficulties and were forced to cut back on or restrain health care expenditures. Home rehabilitation has received attention in recent years because of its potential for cost containment. Often forgotten, however, is the redistribution of costs from one caregiver to another. The aim of this study was to analyse whether a redistribution of costs occurs between health care providers (the County councils) and social welfare providers (the municipalities) in a comparison of home-based rehabilitation and hospital-based rehabilitation after stroke. The study population included 123 patients, 53 in the home-based rehabilitation group and 68 in the hospital-based rehabilitation group. The patients were followed up at 6 and 12 months after onset of stroke. Resource use over a 12-month period included acute hospital care, in-hospital rehabilitation, home rehabilitation and use of home-help service as well as nursing home living. The hospital-based rehabilitation group had significantly fewer hospitalization days after a decision was made about rehabilitation at the acute care ward and consequently the cost for the acute care period was significantly lower. The cost for the rehabilitation period was significantly lower in the home-based rehabilitation group. However, the cost for home help service was significantly higher in the home-based rehabilitation group. The total costs for the care episode did not differ between the two groups. The main finding of this study is that there seems to occur a redistribution of costs between health care providers and social welfare providers in home rehabilitation after stroke in a group of patients with mixed degree of impairment.

Place, publisher, year, edition, pages
2002. Vol. 16, no 4, 386-392 p.
Keyword [en]
home-based rehabilitation, hospital-based rehabilitation, redistribution of cost, stroke, cost
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-13753DOI: 10.1046/j.1471-6712.2002.00115.xOAI: oai:DiVA.org:liu-13753DiVA: diva2:21298
Available from: 2002-12-19 Created: 2002-12-19 Last updated: 2009-10-31
In thesis
1. Health economic studies on advanced home care
Open this publication in new window or tab >>Health economic studies on advanced home care
2002 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The aim of this thesis was to examine the cost-effectiveness of specific advanced home care and home rehabilitation interventions and to improve economic evaluation methods when applied to advanced home care. This included a comparison of two alternative ways of administering oxygen at home to patients with chronic hypoxaemia, as well as a review of scientific evidence on costs and effects of home rehabilitation after stroke. Also included were studies on prominent methodological issues in advanced home care - the redistribution of care efforts among caregivers and costing of informal care efforts.

For patients with chronic hypoxaemia, a randomised, controlled trial showed that mobile liquid oxygen was considerably more costly compared to concentrator treatment. However, the treatment effects showed that liquid oxygen had a better impact on patient quality of life. The literature review revealed that the outcomes and costs of home rehabilitation after stroke are equal to those of alternative treatment strategies. Similar results were obtained in a study comparing hospital-based and home-based stroke rehabilitation, which also showed that there is a considerable redistribution of costs between health care providers and social welfare providers. Studies of patients in advanced home care in the county of Östergötland, Sweden, showed that the cost of informal care constitutes a considerable part of the care effort in all costing approaches used. Also, informal care costs were higher among patients who were men, who were younger, who had their own housing and had a cancer diagnosis.

This thesis reveals that advanced home care interventions can differ regarding costs as well as effects, and thus comparisons between alternative home care interventions must also be performed. Further, redistribution effects are important to consider in evaluations. The cost of informal care is substantial in advanced home care. These costs must be included in evaluations with a societal perspective or else the comparisons will be biased.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2002. 66 p.
Series
Linköping Dissertations on Health and Society, ISSN 1651-1646 ; 2
Keyword
health economics, economic evaluation, advanced home care, redistribution, cost, informal care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:liu:diva-5405 (URN)91-7373-445-4 (ISBN)
Public defence
2002-11-22, Aulan, Hus 240, Campus US, Linköpings universitet, Linköping, 10:00 (English)
Available from: 2002-12-19 Created: 2002-12-19 Last updated: 2012-01-25Bibliographically approved

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Andersson, AgnetaLevin, Lars-ÅkeÖberg, Birgitta

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