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Socio-Economic Analysis of Rehabilitation in Primary Health Care
Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Arts and Sciences.
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aims: The aim was to compare a new strategy for rehabilitation based on coordinated teamwork with traditional health care activities for patients with longterm illnesses in primary health care with respect to costs and health related quality of life.

Methods and data: This was a 3-month, prospective, controlled study in primary health care where a trial group of health care centers with rehabilitation teams (n=665) was compared with a control group of health care centers working with traditional health care activities without co-ordinated teams (n=665). The data collection was carried out for 12 months during the years 1993 and 1994 in 6 geographically defined areas. All individuals in the regions were consecutively included after being on sick leave for more than 30 days. The patients were followed upduring a period of three months using postal questionnaires. The analytical method was cost-utility analysis.

Results: The team based rehabilitation strategy did not improve health related quality of life (p=0.46) compared with traditional rehabilitation. The total costs for health care was 9% lower (p=0.51) and the indirect costs for loss of production was 8% higher (p=0.02) for the trial group. Social insurance expenditures were 9% higher for the trial group (p=0.14).

Discussion: It was not possible to form any reliable conclusions from this short term study about whether rehabilitation teams reduced health status and health related quality of life, as the differences were small but also negative. The perspective of analysis is important, from a health care perspective the teams were cost saving but from a broader socioeconomic perspective the teams lead to increased costs for society. The inclusion of indirect costs in cost-effectiveness analyses andcost-utility analyses requires further exploration. The time period was probably too short for capturing long-term effects.

Conclusions: Rehabilitation teams in primary health care do not improve health related quality of life within a short-term perspective, reduce costs for health care but increase indirect costs and social insurance expenditures compared with traditional health care activities. In order to improve quality of life for those with longterm illnesses and decrease society's costs for rehabilitation, rehabilitation strategiesfor people with different illnesses may be developed into more specialized strategies for specific patient groups, defined into homogenous treatment groups that matchwell-defined rehabilitation. For further research long-term studies are needed.

Keyword [en]
Long-term illness, Rehabilitation, Socioeconomic, Cost-utility, Quality of life
National Category
Social Sciences Interdisciplinary
URN: urn:nbn:se:liu:diva-79116OAI: diva2:538273
Available from: 2012-06-29 Created: 2012-06-29 Last updated: 2012-06-29Bibliographically approved
In thesis
1. Disability, rehabilitation and health economic assessment
Open this publication in new window or tab >>Disability, rehabilitation and health economic assessment
2001 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Disability caused by long-term illnesses and diseases involves welfare losses through human suffering and huge societal costs. Rehabilitation of disabled individuals is a complex and growing field where health economic assessment studies could play a role in health policy and medical decision-making.

Aims: The overall aim was the application of a multidisdplinary framework of health economic assessment of rehabilitation technologies for disabled individuals. A specific aim was to examine the costs for some disabilitygroups, and another aim was to examine the cost-effectiveness of certain rehabilitation technologies for disabled individuals.

Methods: Six empirical studies were used. Cost analyses were applied to disabilities caused by long-term illnesses (Paper I), rheumatic· diseases (Paper II), and severe schiwphrenia (Paper III). A cost-effectivenessanalysis was performed on the rehabilitation of disabled patients with severe schizophrenia {Paper IV). Costutilily analyses were carried out on the rehabilitation of disabled patients with long-term illnesses (Paper V)and schizophrenia (Paper VI).

Results: The socioeconomic costs for the studied disability groups was SEK 1.9 billion for severe schizophrenia, SEK 25.6 billion for long term illness and SEK 62 billion for rheumatic diseases. The proportions of indirect productivity costs were considerable, 67-92% of total costs, and the social insurance expenditures were also high. Rehabilitation technologies based on co-operation between resource providers for disabled patients with schizophrenia improved health status by 26%, health-related quality of life by 27% and quality adjusted life years (QALY's). The costs for health care decreased significantly by 51% and sociely by 28%. Early rehabilitation of disabled patients with severe schizophrenia improved health status, social functioning and increased the health care costs. Rehabilitation of disabled patients with long-term illnesses did not improve health statu..~, quality of life and QALY's in the short run. The costs decreased for health care and the indirect costs increased. In optimizing the cost-effectiveness of rehabilitation technologies, disabled individuals must be precisely defined into homogeneous groups that match well-defined rehabilitation technologies. The costs for all resource providers in rehabilitation must be included in the cost concept in order to avoid underestimation of the socioeconomic costs. A financial analysis of transfer payments was valuable from a decision-maker perspective. The EuroQol-instrumem was sensitive in detecting significant changesin health status and health related qualily of life. One of the shortcomings in the study design i,s due to the lack of resources for health economic assessment studies. Long-term, randomized, controlled studies arc needed.

Conclusions: The application of the framework for health economic assessment to the rehabilitation of disabled individuals showed that the costs for disabilities in society were high, as was the proportion of indirectcosts. Co-operation among resource providers involved in rehabilitation can increase quality of life and save money for health care and society.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2001. 62 p.
Linköping Studies in Arts and Science, ISSN 0282-9800 ; 239
Disability, Rehabilitation, Cost-effectiveness, Cost-Utility, Quality of Life, Rehabilitering, Kostnadseffektivitet, Hälsoekonomi, Sjukvårdsekonomi, Livskvalitet
National Category
Social Sciences Interdisciplinary
urn:nbn:se:liu:diva-35036 (URN)24711 (Local ID)91-7373-110-2 (ISBN)24711 (Archive number)24711 (OAI)
Public defence
2001-09-12, Berzeliussalen, Hälsouniversitetet, Linköping, 13:00 (Swedish)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2014-08-28Bibliographically approved

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