The economics of one person's AT system : first findings

This paper reports on the trial of a novel economic methodology to investigate and analyze the economics of an individual AT user's AT system. Various government reports in Australia have highlighted the inadequacies of government funded AT equipment schemes, many of which have budgetary constraints at their core. Yet delayed or inappropriate provision of AT causes additional monetary and health costs. Our concern here is that the methodologies commonly available to health economists are unable to give a realistic picture of the relationships between cost and effectiveness of complex, individualized systems. Our quest therefore was to develop a methodology that can encompass the complexities of measuring and costing a user's AT system and thereby provides a more realistic appraisal of the real costs associated with the provision and non-provision of optimal AT systems. Adopting a user-centered perspective and a novel use of the International Classification of Functioning, Disability and Health (ICF), a seven step process was devised. The steps were trialed with one AT user. Most of the discussion here focuses on the third and fourth steps that deal with identifying and analyzing costs. In discussing the difficulties in steps three and four, particular emphasis is placed on those related to the public environment. The results revealed that whilst AT devices are essential for improving and maintaining independence, particularly in the domestic environment, the public environment and societal attitudes place major barriers to full participation in social, economic, recreational and civic activities. We conclude that the methodology holds much promise for dealing with the complexities that other economic methodologies tend to ignore, while acknowledging the resource intensity, which will limit the range of practical applications.