Barbara M. Fraumeni Muskie School of Public Service, University of Southern Maine & the National Bureau of Economic Research, USA IARIW, Session 3 Joensuu, Finland August 22, 2006 A Framework for Quality Adjustment Across UK Public Services By Jim Ebdon and Ogho Okiti, ONS, UK

Muskie School of Public Service Ph.D. Program in Public Policy GOALS  Establish a consistent framework across all UK public services  Differentiate and cover representative service sub-types  Quality adjust via degree of success & contribution to outcomes

Muskie School of Public Service Ph.D. Program in Public Policy Differentiation of Services  As detailed and homogeneous as possible  Avoids confounding of structural and quality changes  Even when costs are predominantly staff costs, assuming cost and quality correspondences may be problematic  Switch from marginal cost to value weights

Muskie School of Public Service Ph.D. Program in Public Policy Degree of Success  Atkinson: ‘a quality improvement is equivalent to getting a larger package.”  Need to measure output quality changes, not just process quality changes  Avoid double-counting  Example of timeliness and accuracy for social security benefits processing

Muskie School of Public Service Ph.D. Program in Public Policy Contribution to Outcome  Eurostat handbook backs use of outcome indicators to adjust for quality  Attribution and time lag: an education example

Muskie School of Public Service Ph.D. Program in Public Policy Case Study: Adult Social Care Differentiation of Services 23 categories of services, where data exists, by  Type of service  Client group  Type of home

Muskie School of Public Service Ph.D. Program in Public Policy Outcome Adjustments  Care weeks, intensity of care, and quality of care  Methodology from the Personal Social Services Research Unit (PSSRU) of the University of Kent  Concentrated on current welfare gains  9 dimensions of outcome, such as personal cleanliness & comfort and control over daily life (see para. 4.6)

Muskie School of Public Service Ph.D. Program in Public Policy Capacity for Benefit (CfB)  Assessments by service clients  Level of benefit if the intervention per week was perfect  Needs were categorized as high, low, or no needs  Could not separate CfB into two types of home care, but could measure CfB by intensity of care  Average CfB per week for home care was about 2 (of a max of 7)  CfB among admissions to care homes by type grew between 13% and 18% from 1995 to 2004

Muskie School of Public Service Ph.D. Program in Public Policy Capacity for Benefit PSSRU Background Paper  Understanding Tables 4.3 and 4.4 (after para. 4.15)  Aggregate CfB’s of subcomponents by  Equal weights for the 9 dimensions of outcomes  Or by weights for the Older Persons Utility Scale (OPUS) which covered 5 dimensions of outcomes; with equal and low weights for two of the remaining domains

Muskie School of Public Service Ph.D. Program in Public Policy Output Index = Capacity for Benefit X Quality Adjustment X Weeks of Help

Muskie School of Public Service Ph.D. Program in Public Policy Adjusting for Degree of Success and Client Experience – Quality  Satisfaction surveys focusing on dimensions such as attitudes of care-workers  Separate data for client experience and elements of care delivered are not available currently  Degree of success and client experience are both on the future work agenda

Muskie School of Public Service Ph.D. Program in Public Policy Comments  Consistent framework, differentiation of services with representation, and quality adjustment goals are commendable  Evaluation by service clients can be tricky  Authors well aware of outcome pitfalls  How about consumer surplus pitfalls?  Use of the word “welfare” makes me nervous  Keep up the good work