A methodology for an EU cross-country comparison? Public expenditure for drug treatment in hospitals dr. & prof. dr. Freya Vander Laenen Freya.Vanderlaenen@UGent.be
Background 2 COMPARATIVE DRUG POLICY ANALYSIS Multiple approaches: government spending, burden of disease, drug consumption, drug policy index, etc. However: lack of available data, differences in methodology, comparability problems between countries valid cross national comparison: common conceptual and methodological framework FOCUS OF THE CURRENT STUDY government spending for drug treatment EU cross country comparison with a uniform methodology
Methodology 3 Systematic literature review on the methods and data sources to estimate the drug treatment expenditures (Lievens & Vander Laenen, 2013) CALCULATION METHODS OF DRUG TREATMENT EXPENDITURES Methodology varies among the types of treatment (and between countries) method depends on the availability and quality of the data Except for hospitals: unit expenditure (cost per hospitalisation day) INTERNATIONAL DATA SOURCES Databases of international organisations/networks (OECD, WHO, EMCDDA, United Nations, EMA, ECDC and World Bank) limited data on drug treatment (activities and funding) available Except for Eurostat: hospital acitivities (hospital days by diagnosis) and health care expenditures (by provider/by type of financing agent) average cost per hospital day x hospital days for treating illegal drug disorders
Results 4 Cross country comparison of illegal drug treatment expenditures by hospitals for 15 EU member states Average of EU 15: 5 euros per capita or 0,013% of the GDP Large variation across the EU member states Western European countries (e.g. Luxembourg, Austria and Germany): above the average of the EU 15 (7.2 39.5 euros per capita and 0.022% 0.056% of GDP) Eastern European countries (e.g. Romania, Lithuania, Bulgaria and Latvia): low hospital expenditures per capita ( 0.3 euros) and in proportion to the GDP (0.002% of the GDP)
Results Table 1: Hospital days and expenditures for illegal drug treatment (general, mental health and specialty hospitals), for 15 EU countries, 2012 5 Country Public expenditure per hospital day (euros) Hospital days for illegal drug treatment per 1,000 capita Illegal drug treatment expenditure by hospitals, per capita (euros) Illegal drug treatment expenditure by hospitals, as percentage of GDP Luxembourg 1328 30 39.5 0.056% Austria 634 16 10.2 0.030% Germany 416 17 7.2 0.022% Czech Republic 238 19 4.4 0.020% Sweden 1884 2 4.3 0.013% Slovenia 433 8 3.5 0.016% Finland 518 6 3.4 0.011% Slovakia 164 12 2.0 0.010% Poland 181 6 1.1 0.006% Hungary 110 8 0.9 0.005% Portugal 812 0.7 0.6 0.003% Latvia 112 3 0.3 0.002% Bulgaria 76 2 0.1 0.001% Lithuania 126 0.7 0.1 0.000% Romania 83 0.5 0.04 0.000% Mean (SD) 474 9 5 0.013%
Discussion 6 WAYS OF IMPROVING DATA REGISTRATION AND ANALYSIS International databases should be expanded Hospital expenditures: increase data coverage Eurostat database more reliable results for each of the EU MS (> 15 EU MS at present) Include registration for all types of treatment expenditures in national registration ( > supplement Eurostat database) outpatient services, inpatient treatment services, treatment in prisons, HR and social reintegration How? Use TDI for total number of clients / type of treatment Still missing: number of treatment activities/days & unit cost/treatment
Discussion 7 A MULTIDIMENSIONAL MODEL FOR IMPROVING THE ANALYSIS OF PE RESULTS Government policy Health care policy Drug policy 1. Health care organisation 2. Source of financing Socio economic context 1. Economic power (GDP) 2. Size of the country Drug policy mix Drug treatment policy 1. Prevalence 2. Treatment organisation and provision 3. Treatment access general context drug related context
Discussion 8 A MULTIDIMENSIONAL MODEL FOR IMPROVING THE ANALYSIS OF PE RESULTS Reflections model: + context beyond drug treatment related issues/policy + valuable basis for assessment PS on drug treatment policy + explain countries in drug treatment expenditures + could be applied to other health problems (+ comparison between) no external factors included (e.g. community values, EB, political spectrum) no model for (economic) evaluation drug treatment policy (~ (C)EA & CBA) Missing data to implement model: Prevalence rates problem drug use for recent years Drug treatment interventions: number of clients/activities ( TDI) and (unit) cost information Drug treatment policy mixes
Literature 9 LIEVENS, D., VANDER LAENEN, F., CHRISTIAENS, J. (2014). Public spending for illegal drug and alcohol treatment in hospitals: an EU cross country comparison, Substance Abuse Treatment, Prevention, and Policy, 9: 26. LIEVENS, D., VANDER LAENEN, F., Literature survey on the methods used to estimate public expenditure on illicit drug treatment in Europe and beyond. Report for the EMCDDA. LIEVENS, D., VANDER LAENEN, F., CAULKINS, J., DE RUYVER, B. (2012). "Drugs in Figures III: study of public expenditures on drug control and drug problems", in Cools et al., Gofs Research Paper Series, European Criminal Justice and Policy. VANDER LAENEN, F., VANDAM, L., DE RUYVER, B., LIEVENS, D. (2011). Studies on public drug expenditure in Europe, possibilities and limitations, Bulletin on Narcotics, vol. LX. VAN MALDEREN, S., VANDER LAENEN, F., DE RUYVER, B. (2009). The study of expenditure on drugs, a useful evaluation tool for policy, in Cools et al., Gofs Research Paper Series, Contemporary Issues in the Empirical Study of Crime.
Freya Vander Laenen Freya.Vanderlaenen@UGent.be IRCP Ghent University Universiteitstraat 4 B 9000 Ghent