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ABSTRACT
This study investigates whether the Swedish national entitlement legislation, which is known to be one of the most developed in Europe for persons with intellectual disabilities or autism, accomplishes its aim to provide equal quality of day services independent of location. We estimated a reduced-form model of demand and supply-side determinants of a latent quality variable for day-service programmes using panel data on expenditure per attendee for the 290 Swedish municipalities 2004–2012. We found that expenditure per attendee is among others affected by changes of the local tax base and outcome in elections to the local assemblies. These results imply that rights of persons with intellectual disabilities with regard to equal quality of day services independent of where they live are not fully honoured in budget allocation decisions made by local governments.
ABSTRAKT
Denna studie undersöker vilka ekonomiska och politiska faktorer som samvarierar med kostnad per brukare i daglig verksamhet i svenska kommuner. Det finns ännu inga nationella mätningar av kvaliteten från brukarsynpunkt som gör det möjligt att studera om personer som är berättigade till daglig verksamhet enligt Lag om stöd och service till vissa funktionshindrade (LSS) ges service av hög och likvärdig kvalitet oavsett bosättningsort. Servicenivån ska inte, som på många andra utgiftsområden, vara avhängig av lokala politiska prioriteringar. Ändå skiljer den genomsnittliga kostnaden per brukare väsentligt mellan olika kommuner. Detta skulle dock kunna bero på skillnader i kostnadsläge eller andra förutsättningar som kommunerna inte kan påverka. I studien skattades en ekvation för kostnaden per brukare i svenska kommuner med paneldata för åren 2004-2012 med förklarande variabler som speglar kostnadsförutsättningar (utbudsfaktorer) eller budgetprioriteringar (efterfrågafaktorer). Vi fann att utgiften per brukare korrelerar med bland annat förändringar i skattebas och politisk majoritet. Dessa resultat implicerar att kommunerna utifrån egna prioriteringar väljer olika ambitionsnivå för innehållet i daglig verksamhet trots att LSS är en rättighetslag och trots de nationella system som finns för att utjämna kostnadsskillnader.
Acknowledgements
We are grateful for comments from Linda Andersson, Mikael Svensson, two anonymous reviewers, and participants at the Economics seminar at Örebro University and the Annual Meeting of the Swedish Health Economics Association, Göteborg 2016.
Disclosure statement
No potential conflict of interest was reported by the authors.
Notes on contributors
Lars Hultkrantz is professor of economics at the Örebro University School of Business and a member of the Expert Group on Public Economics (ESO) at the Swedish Ministry of Finance. His current research interest is cost-benefit analysis.
Emelie Värja recently received a Ph.D. in economics at the Örebro University School of Business and is currently employed as an advisor at PwC Sweden. Her research interests involve equality and efficiency issues in local government.
Susanna Larsson Tholen is an Affiliated Researcher at the School of Health Science at Örebro University and belongs to the Swedish Institute for Disability Research (SIDR).
Notes
1 For instance, it was reported in England 2004 that only 24% of people with long-term mental health problems in England were in work, which was the lowest employment rate of any of the main groups of persons with disabilities (SEU, Citation2004). Sheppard-Jones (Citation2002) in a study of quality of life for adults with developmental disabilities in Kentucky, US, reports that in a sample of respondents receiving services from the state developmental disability authority 50% wanted to work more, in contrast to a sample of the general population. She finds that adults with developmental disabilities are at a significant disadvantage with regard to quality of life, for instance feeling lonely.
2 It was funded by contributions (tithe) from the landowners in the parish and governed by the parish council which consisted of all landowners. In 1734 all parishes were required to have an almshouse.
3 The income equalisation grants are given to municipalities with a weak tax base to guarantee a tax base of 115% of the countries mean tax base; municipalities with a higher tax base have to pay a fee. The cost-equalisation grants are intended to equalise with respect to so called uncontrollable structural cost differences. Also here, municipalities with a more favorable cost structure pay a fee. There are also some other smaller grants but these two represent 97% of the total equalisation grants. In the statistical analysis we estimated models including both these variables; however that did not affect the results of our variables of interest.
4 A person entitled to assistance benefit from the Social Insurance Administration must pay the equivalent amount to the municipality if the municipality provides the assistance.
5 The total cost of these services in England was 3030 million GBP (Health and Social Care Information Centre, Citation2014). Curiously, our calculation of the per capita cost in both countries using the current exchange rate resulted in precisely the same number, 80 Euro (SEK 657).
6 See, for example, Henderson (Citation1968), Aronsson and Wikström (Citation199Citation6), Josselin, Rocaboy, and Tavera (Citation2009).
7 See Hindriks and Myles (Citation2013) for an advanced textbook treatment. Josselin et al. (Citation2009) find, based on French data that the ‘pure’ median-voter model works best for small communities.
8 This is in analogy with the standard two-stage (2SLS) approach used for market goods where, in a first stage, a reduced-form price equation is estimated on exogenous demand- and supply-side variables (which in a second stage is used to create an instrument variable for estimation of the demand and supply equations).
9 More precisely, the sum of the county and municipality tax rates.
10 This was a cross-sectional spatial-econometrics analysis to investigate to what extent nearby municipalities influence each other in decision on total LSS expenditure. It did not exploit the panel structure of the data.
11 Such programmes are provided both as state-funded labour-market programmes and as municipality-funded programmes for persons living on welfare, youth in need of internships etc.
12 As with Tax base, it would be interesting to separate the demand from the supply effect, but we have not been able to find an instrument that effect the unemployment rate in a municipality but not the opportunities of finding simple-task jobs; as the variable is not endogenous it will not affect the results.
13 All data are available on request from the corresponding author.
14 We have observations on all years for 209 municipalities. Among the municipalities with missing observations 26 is missing 1 year, 35 has 2 missing years, 4 municipalities has 3 missing years, 1 has 4, 3 has 5 and 1 has 6 and 7, ending up with 2380 observations.
15 Using only new-born children or children in other age groups does not alter the results.
16 Parents that are qualified for parental leave payment can get such payment for 480 days, of which 390 days with full payment. ‘Full payment’ corresponds to 80% of the monthly salary, but is capped at a certain level (around 4000 Euro/month). For the remaining 90 days and for parents that have not qualified (for instance by not have being working during the whole qualification period of 270 days, the payment is considerably lower.
17 These results are available on request from the corresponding author.
18 Because Grant can take negative values for municipalities that pay a fee instead of receiving a grant, we have divided this variable by 100,000 and then added 1 before taking the logarithm.
19 Similar results were held with other sets of plausible instrument variables. These can be held on request to the corresponding author.