....such an injury would vex a saint.1
The Spinal Injuries Association (SIA) is a not-for-profit organization, which has a charter is to provide facilities and assistance to people with paraplegia or quadriplegia. The stated role of the SIA is to "work cooperatively with the community to support equity and equal opportunity for people with spinal cord" (Paraplegic & Quadriplegic Association of Queensland 2004:3). One of the association's central functions is the coordination and provision of personal care services to people with a spinal cord injury (SCI).
The Queensland Government supports a small number of people with SCI through the Adult Lifestyle Support Program (ALSP). Believing that there is anecdotal evidence, which demonstrates that access to an ALSP improves the economic outcomes for people with an SCI, the SIA approached the Centre of National Research on Disability and Rehabilitation Medicine (CONROD) to complete a formal economic evaluation of the ALSP. The SIA have stipulated that the evaluation should consider the following consequences of the ALSP (i) health care, (ii) employment, (iii) quality of life and (iv) the effects on the family of a person with an SCI.
Under the supervision of Dr Luke Connelly I have agreed to complete a formal cost benefit analysis (CBA) of the ALSP for my Masters in Health Economics thesis. To measure the effects of the ALSP it was necessary to conduct an observational survey study of the SIA membership. My tasks were to (i) design the survey, (ii) administer the mail-out questionnaire to 250 people with an SCI, and (iii) collate the data. In due course we will analyse the entire data set that has been gathered and report to the SIA on all areas of interest. My dissertation will commence but not complete that process. Employment was selected for analysis and the findings presented in the concluding chapter.
Chapter one will introduce the thesis by first defining the public health dimension of spinal cord injury in Queensland and then describing the ALSP which is a public health initiative of the Queensland Government. Chapter one will conclude by reviewing two pieces anecdotal evidence which provide an insight into the contribution that the ALSP makes to the community.
Chapter two will consider how the neo-classical welfare-economic framework can be used to support a public intervention such as the ALSP. This analytical paradigm will be used to firstly review the efficiency arguments for intervention and consider the possible relevance to the market for home care services. The second half of chapter two will review the equity arguments, which might also support intervention in the market.
Chapter three will summarise the economic evaluations of spinal cord injury. Both partial and full economic evaluations were analysed to assist in the designing a methodology to evaluate the economic impact of the Adult Lifestyle Support Package. The discussion will conclude by introducing the potential issue of endogeneity and outline the implications for the analysis of the ALSP.
Chapter four will outline the methodology employed and commences with a synopsis of the theoretical complexities of the relationship between costs and benefits of the ALSP. The proceeding discussion focuses on how this relationship might be estimated. Issues to be addressed include (i) the sampling technique employed, (ii) survey content and design. Consideration of all the pertinent issues culminated in the creation of a Mail-out survey which was titled "An Evaluation of the Support provided to the Residents of Queensland Living with a Spinal Cord Injury". This survey will be subsequently referred to the Survey of Residents Living with an SCI.
Chapter five will present descriptive statistics generated from the survey data. The presentation will include the utilization of the ALSP by people with an SCI as well as a description of the potential benefits of concern which were (i) health care, (ii) employment, (iii) quality of life and (iv) the opportunity cost of family care. Data collected on the covariates provides a socio-economic profile of the cohort. The description concludes by presenting the average costs and benefits of people with and without access to an ALSP.
Chapter six narrows the focus of the dissertation to the econometric analysis of the effect, if any, of the ALSP on the labour market outcome for people with an SCI. The analysis will consider (i) the probability of employment and (ii) wage income. Care will be taken to ensure that potential issues of endogeneity, which are common to observational studies, do not undermine the internal validity of this analysis.
1 Shakespeare, The Taming of the Shrew, 1593, III, ii 28, as cited in Ohry & Ohry-Kssoy, 1989