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Cost Program: Barbados Experience

Cost Program: Barbados Experience. Jonathan M. Yearwood Research and Information Officer National Council on Substance Abuse (NCSA). Barbados’ Contribution to the Cost Study. Estimating The Human, Social, and Economic Costs of Drugs in the Americas.

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Cost Program: Barbados Experience

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  1. Cost Program: Barbados Experience Jonathan M. Yearwood Research and Information Officer National Council on Substance Abuse (NCSA)

  2. Barbados’ Contribution to the Cost Study Estimating The Human, Social, and Economic Costs of Drugs in the Americas

  3. Barbados’ Contribution to the Cost Study The NCSA (Barbados) conducted three (3) separatestudies. These reports were: • Estimating Direct Government Expenditure on Drug Demand Reduction in Barbados (November 2003) • Survey of Emergency Rooms in Barbados (September 2004) • The Estimation of Costs Attributable to Substance Abuse and Loss of Productivity for Inmates at Glendairy Prison: Barbados (November 2004).

  4. Estimating Direct Government Expenditure on Drug Demand Reduction in Barbados (EDGE)

  5. Objectives of the EDGE Study The main objectives of the study were: • To estimate Government Expenditure on demand reduction activities; • To collect and report data required for the indicators known as level one indicators; • To provide a basis on which to build future studies as the pilot project progresses.

  6. Methodology The methodology employed was: • The use of secondary data on drug related costs and activities for some institutions in the health and criminal justice sectors. • The secondary data provided the basis for estimating government expenditure.

  7. Year Institution 1996 1997 1998 1999 2000 NCSA $624,457 $678,323 $706,077 $989,036 $1,256,049 Drug Rehab Unit $4,578,509 $4,954,810 $4,436,461 $2,221,621 $2,093,553 Total $5,202,966 $5,633,133 $5,142,538 $3,210,657 $3,349,602 Table 1 Estimates of Total Government Expenditure on Demand Reduction

  8. Figure 1Estimate of Total Government Expenditure on Demand Reduction

  9. Analysis of EDGE Study • Administrators need to keep track of spending. • No data is provided for yearly requests and therefore an estimate cannot be provided.

  10. Analysis of EDGE Study • A standardised data collection instrument for all health-care providers. • Central depository for studies of this type will be needed.

  11. Survey of Emergency Rooms in Barbados (The ER Study)

  12. Objectives of ER Study • To determine the prevalence of drug use in the patients • To establish the relative importance and the characteristics of drug use • To quantify the association between drug use and accidents. • To test a methodology that may be easily applied in different countries. • Collect data on Level 1 direct cost indicators..

  13. Methodology • The study was conducted at the two institutions (QEH and FMH). • A CICAD standardized questionnaire was used. • Interviews were conducted on a 24-hour & 18 hour respectively. • The study was conducted among persons - 12 years and older. • Data was collected a two-week period.

  14. Survey Information • Patient Data collected: • the date and time of the emergency; • basic demographics of the patients; • type of emergency; • substance use in the six hours prior to the interview; and • the possible relationship between consumption and the emergency. • Doctor’s clinical impression was noted • No laboratory tests were conducted

  15. Estimation of ER Cost Data - QEH • The 1996 by Boston University Report guided the survey. • The cost data for the survey was based on assumed patterns of expenditure for 1995 – 2003.

  16. Pattern of Expenditure for QEH In 1995: • Expenditure on the QEH = $83.9m. • $5.2m (6.2%) – A & E services. In 2002 – 2003 • Expenditure on the QEH = $115.3m. • $7.15m (6.2%) A & E services

  17. Pattern of Expenditure for QEH Cont’d The ER study shows – • 3.6% had an emergency related to drug use; • 3.6% of the expenditure was consistent for two years; • Estimated cost for 2002 – 2003 =3.6% of 7.15m ($260,000) could have been spent on drug related accidents at the QEH.

  18. Analysis of ER Study • Survey was conducted over a normal two (2) week period. • Estimate of 0.8% of admissions are drug related. • A rough estimate of admittances from drug consumption should be given.

  19. The Estimation of Costs Attributable to Substance Abuse and Loss of Productivity for Inmates at Glendairy Prison in Barbados(The Prison Study)

  20. Objectives of the Prison Study • Objectives of the prison study were to determine: • The relationship between drug use and criminal behaviour; • The frequency of drug use; • Persons imprisoned for crimes or offences associated with substance use; • Type of offences committed; • The economic loss due to drug related crime

  21. Methodology • A random stratified sample among non-remand inmates; • 150 inmates were chosen; • The actual sample size was 140 inmates (93%)

  22. Stratified Sample

  23. Major Categories of the Survey • Under the influence of illicit drugs and alcohol. • Acquisition of drugs. • Involvement in the drug economy. • Drug trafficking and production:

  24. Economic Loss Due to Drug-related Crimes The formula Cost of incarceration Loss of productivity cost Economic cost of a prisoner (Perez et al 2004) +

  25. Cost of Incarceration Results • The average cost • Daily = BDS $33.65. • Over eight years (1996 -2004) = $72,962.83. • To maintain the 19 inmates for the duration of their sentences BDS $1,386,293.69.

  26. Loss of Productivity Results • The average loss of productivity • BDS $14,378.42 • The total loss of productivity • BDS $273,190.00 • Almost four times less than the cost of housing the prisoners.

  27. Total Economic Loss • 19 (10%) inmates over the eight year period • BDS$87,341.25 • The total economic loss to Barbados • $1,659,483.69, • Estimated cost to the Barbadian government • $16,600,000.00

  28. Analysis Prison Study • The formula is unclear as outlined below: • Number of Convictions vs. Total sentences: • Length of Sentence:

  29. Analysis Prison Study Cont’d A systematic database of prison records which includes • reason for incarceration, • length of sentence, • profession and • average income.

  30. Analysis Prison Study Cont’d Estimating loss of productivity: • Due to the non-normal distribution of income in Barbados, the loss of productivity would be underestimated. • If median income in the island is utilised, a more accurate figure may result.

  31. Conclusion • The Cost Studies provided baseline data from which government expenditures on demand reduction activities and prison costs could be estimated. • These costs estimations may vary from existing government procedures for estimating costs.

  32. Conclusion • The gap between government estimates and those of the cost studies may vary due to the presence of other tangible and intangible costs absent from the cost study estimates.

  33. What is therefore needed is a bridging of government and cost study estimates which will allow for more robust costs estimations.

  34. Discussion

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