Rehab assumptions driving millions in ACC spending

Flawed rehab assumptions driving millions in ACC spending

Failure to prioritise active rehabilitation for people with long-term and complex disability in an effort to rationalise spending could be costing New Zealand hundreds of millions of dollars.

King’s College Professor Lynne Turner-Stokes says a “broader church of evidence” should be considered by funders making decisions about rehabilitation funding.

Turner-Stokes, who is presenting her findings at AUT University today [MONDAY October 4], says a focus on narrow research has seen an incorrect assumption develop that severe traumatic brain injury (TBI) sufferers and others with complex disability will not benefit sufficiently from rehabilitation.

Instead Turner-Stokes says in the most serious cases of brain injury, rehabilitation can produce small but critical gains in independence and allow an individual to return to work, equating to savings of hundreds of thousands over a lifetime.

Director of AUT University’s Person-Centred Rehabilitation Team Kath McPherson, who has worked with Turner-Stokes on several projects, says there are significant implications for New Zealand’s funding models.

“There has been a drive toward ‘pragmatic’ application of funding, with the suggestion that the bulk of funding should go to those who will show the most dramatic improvements from rehabilitation. This research shows that smaller levels of improvement are very valid.”

“Even ignoring the fact that there is immeasurable value in restoring someone’s independence, even to a small degree, [Turner’s] research shows there is a concrete financial return for funders like ACC who invest in rehabilitation for even the most serious TBI sufferers or those with spinal injuries.”

In New Zealand, McPherson says the lifetime liabilities costs for someone disabled by a serious brain or spinal injury are upwards of $20 million, including home help and attendant care, equipment and home modifications.

McPherson says there is a clear risk of greater ACC liabilities over time if an individual does not regain their optimum level of functioning and becomes increasingly isolated and dependent.

“Carer and home help costs could actually escalate over time and you could be looking at lifetime liabilities of million of dollars.”

McPherson says rehabilitation will be a factor in managing escalating costs from people disabled by injury.

“The number of people disabled through injury is growing slowly, but the cost of supporting these people is growing at a much faster rate. The average cost per claim increased by 14% last year and this follows significant growth in claim costs in previous years.”

“What is exciting to me about this research to see is the human argument for providing rehabilitation and not just care and support for those with very complex needs is met by fiscal ones.”

Turner-Stokes’ UK-based research indicates a high-dependency patient admitted for intensive rehabilitation for 155 days at a cost of £41,782 would reduce their dependency on a carer by 16 hours a week.

The reduced carer costs would save £639 a week and the investment in rehabilitation would be recouped after 16 months.

“The UK is developing single national tariff system for its services and we have been working with the UK Department of Health to develop a system that adequately takes account of different levels of patient complexity, so that patients with very complex needs, who cost a lot more to treat, are not disadvantaged by a system that does not adequately cover the costs of treating them.”

“We are trying to come with a system that is fair both to the service providers and the purchasers, so that we make the best use of resources available.”

Turner’s work has questioned the reliance on randomized control trials to assess the effectiveness of rehabilitation and instead focused on more expansive measurement tools such as Functional Independence Measure
(FIM) and Functional Assessment Measure (FAM).

ENDS

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