![Sample our Health and Social Care journals, sign in here to start your FREE access for 14 days]({"type":"image" , "src" : "/sda/5938/TOC-Subject-Sample-2021-Health-Social-Care.jpg"})
Abstract
Purpose. This paper identifies key methodological issues for economic analyses of costs and effectiveness of Assistive Technology (AT) systems based on the International Classification of Functioning, Disability and Health (ICF). Following the biopsychosocial model of the ICF, the paper explores the consequences for cost-effectiveness analyses of AT systems when a user centred approach is taken. In so doing, the paper questions the fiction of neutrality in economic analyses and discusses the distinction between weak and strong objectivity.
Method. Costs are measured as all resources used when providing a particular level of environmental facilitators and reducing environmental barriers for an AT user, while effectiveness is measured in terms of the resulting increase in activities and participation of the AT user. The ICF's fourth qualifier for activities and participation, which denotes performance without assistance is used to identify the additional performance achieved due to the particular environmental factors in the current situation (first qualifier). A fifth qualifier for activities and participation is introduced to denote performance with optimal assistance, and the fourth qualifier is then again used to identify the increase in activities and participation due to the environmental factors in the situation with optimal assistance.
Results. The effectiveness that an AT user achieves in his or her current situation can be compared with the effectiveness he or she could achieve when provided with what is considered an optimal AT system based on current technologies and user priorities. This comparison throws into sharp relief the role of AT systems as well as of universal design (UD) in reducing environmental barriers for AT users in a way that is cost-effective for society as a whole.
Conclusion. Cost-effectiveness analysis based on the ICF can provide powerful economic evidence for how best to allocate existing funding for AT systems. We can identify three particular scenarios in which clear recommendations can be made. In addition, cost-effectiveness analysis provides a means to identify how society can comply with its obligation towards all its members in the most cost-effective way, using a combination of AT and UD.
Notes
1. In the context of housework in general and of care work in particular economists are rather quick in making exceptions to the rule of considering opportunity costs as the economically relevant costs. In these contexts economists often either assume that family members use their ‘own time’, which is then assumed to be leisure time with no monetary value, or they assume housework and care work to be unskilled work and thus to be paid at the minimum wage. Such inconsistencies in economic theory have been discussed extensively in the journal Feminist Economics and elsewhere in the context of the invisibility of what traditionally has been considered as women's work.
2. The need to consider whole AT systems has been discussed in a variety of contexts by a number of authors, not least in the context of abandonment of AT devices, which is obviously of particular relevance to any economic analysis Citation[2],Citation[3]. Various models have been developed from a psycho-social perspective, e.g., the Matching Person and Technology model by Marcia Scherer Citation[4] or the Human Activity and Assistive Technology model by Al Cook and Susan Hussey Citation[5].
3. Most randomized controlled trials fall into this category.
4. At this stage the reader may recall that as ‘d’ stands for activities and participation, we are here dealing with a number of dimensions, depending on the level of the ICF classification, to which we want to take our analysis. There are nine chapters of activities and participation and each chapter has one or several blocks. So if we were to do our analysis at the level of blocks, we would already have 21 dimensions for activities and participation. While the level of detail depends on the purpose of the analysis, 21 dimensions is already a sizeable number in terms of complexity. Yet in terms of the level of detail occupational therapists for example are used to in their case descriptions, it is still a rather aggregated view with all the shortcomings of aggregation.
5. This brief characterisation does by no means claim to do the two positions justice, it only serves as an illustration of key differences relevant to the ICF's own position.
6. In the context of philosophy of science Harding explains how this includes addressing not only questions of method (questions regarding the techniques for gathering evidence), but also questions of methodology (questions related to how research should proceed) and of epistemology (questions about an adequate theory of knowledge or justificatory strategy) Citation[14].