Cost-utility analysis of high- vs. low-intensity home- and community-based service interventions

Charles A. Smith, Kevin Frick

Research output: Contribution to journalArticle

Abstract

Home- and community-based services (HCBS) have been advocated as a mechanism to delay institutionalization and reduce health care costs for the growing senior population. Studies of costs to date have found little evidence of cost savings from HCBS. However, HCBS can be thought to have two main benefits: delaying institutionalization and improving quality of life. Since cost and quality of life can be considered simultaneously in a cost-effectiveness analysis, an exploratory study was conducted to examine the relative cost-effectiveness of a high-dosage (i.e., high-intensity) HCBS intervention (i.e., 1915c Medicaid waiver) compared to a lower-dosage HCBS intervention (i.e., in-home aide service) using quality-adjusted life years as the measure of effectiveness. Findings indicated that high-dosage HCBS is not a cost-effective alternative. The low-dosage alternative allows for greater equity through provision of service to a larger pool of individuals in need.

Original languageEnglish (US)
Pages (from-to)75-98
Number of pages24
JournalSocial Work in Public Health
Volume23
Issue number6
DOIs
StatePublished - Sep 18 2008

Fingerprint

utility analysis
Social Welfare
Cost-Benefit Analysis
costs
community
Institutionalization
Costs and Cost Analysis
Quality of Life
institutionalization
quality of life
Quality-Adjusted Life Years
Cost Savings
Medicaid
Health Care Costs
savings
equity
health care
Population

Keywords

  • Dosage
  • Home- and community-based services
  • Medicaid waiver
  • Quality-adjusted life years

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health
  • Health(social science)

Cite this

Cost-utility analysis of high- vs. low-intensity home- and community-based service interventions. / Smith, Charles A.; Frick, Kevin.

In: Social Work in Public Health, Vol. 23, No. 6, 18.09.2008, p. 75-98.

Research output: Contribution to journalArticle

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