Barbara M. Fraumeni Muskie School of Public Service, University of Southern Maine

1. A Framework for Quality Adjustment Across UK Public Services By Jim Ebdon and Ogho Okiti, ONS, UK Barbara M. Fraumeni Muskie School of Public Service, University of Southern Maine & the National Bureau of Economic Research, USA IARIW, Session 3 Joensuu, Finland August 22, 2006

2. Muskie School of Public Service Ph.D. Program in Public Policy • GOALS • Establish a consistent framework across all UK public services • Differentiate and cover representative service sub-types • Quality adjust via degree of success & contribution to outcomes

3. Muskie School of Public Service Ph.D. Program in Public Policy • Differentiation of Services • As detailed and homogeneous as possible • Avoids confounding of structural and quality changes • Even when costs are predominantly staff costs, assuming cost and quality correspondences may be problematic • Switch from marginal cost to value weights

4. Muskie School of Public Service Ph.D. Program in Public Policy • Degree of Success • Atkinson: ‘a quality improvement is equivalent to getting a larger package.” • Need to measure output quality changes, not just process quality changes • Avoid double-counting • Example of timeliness and accuracy for social security benefits processing

5. Muskie School of Public Service Ph.D. Program in Public Policy • Contribution to Outcome • Eurostat handbook backs use of outcome indicators to adjust for quality • Attribution and time lag: an education example

6. Muskie School of Public Service Ph.D. Program in Public Policy • Case Study: Adult Social Care • Differentiation of Services 23 categories of services, where data exists, by • Type of service • Client group • Type of home

7. Muskie School of Public Service Ph.D. Program in Public Policy • Outcome Adjustments • Care weeks, intensity of care, and quality of care • Methodology from the Personal Social Services Research Unit (PSSRU) of the University of Kent • Concentrated on current welfare gains • 9 dimensions of outcome, such as personal cleanliness & comfort and control over daily life (see para. 4.6)

8. Muskie School of Public Service Ph.D. Program in Public Policy • Capacity for Benefit (CfB) • Assessments by service clients • Level of benefit if the intervention per week was perfect • Needs were categorized as high, low, or no needs • Could not separate CfB into two types of home care, but could measure CfB by intensity of care • Average CfB per week for home care was about 2 (of a max of 7) • CfB among admissions to care homes by type grew between 13% and 18% from 1995 to 2004

9. Muskie School of Public Service Ph.D. Program in Public Policy • Capacity for Benefit • PSSRU Background Paper • Understanding Tables 4.3 and 4.4 (after para. 4.15) • Aggregate CfB’s of subcomponents by • Equal weights for the 9 dimensions of outcomes • Or by weights for the Older Persons Utility Scale (OPUS) which covered 5 dimensions of outcomes; with equal and low weights for two of the remaining domains

10. Muskie School of Public Service Ph.D. Program in Public Policy Output Index = Capacity for Benefit X Quality Adjustment X Weeks of Help

11. Muskie School of Public Service Ph.D. Program in Public Policy • Adjusting for Degree of Success and Client Experience – Quality • Satisfaction surveys focusing on dimensions such as attitudes of care-workers • Separate data for client experience and elements of care delivered are not available currently • Degree of success and client experience are both on the future work agenda

12. Muskie School of Public Service Ph.D. Program in Public Policy • Comments • Consistent framework, differentiation of services with representation, and quality adjustment goals are commendable • Evaluation by service clients can be tricky • Authors well aware of outcome pitfalls • How about consumer surplus pitfalls? • Use of the word “welfare” makes me nervous • Keep up the good work