1. Future research agenda: making the economic case for investing in support for growing older with disabilities David McDaid LSE Health & Social Care & European Observatory on Health Systems and Policies, London School of Economics Growing Older With A Disability Conference, Festival of International Conferences on Caregiving, Disability, Ageing and Technology (FICCDAT) June 2011 d.mcdaid@lse.ac.uk

2. Structure Why should we be interested in economics? Making use of economics in the research agenda on GOWD Some examples of how economics has been used Moving forward

3. Why should we be interested in economics?

4. Economics is just about choice? Budget Supporting people GOWD Support for children with intellectual difficulties

5. Just about e conomic evaluation? The effectiveness question: Does this intervention work? The economic question: Is it worth it?

6. Two Basic Needs: (A) Costs and Outcomes; (B) 2+ Alternatives Outcomes (e.g. Quality of Life Years (QALYs) for intervention X Costs for intervention X; Impact on other costs Costs for intervention Z; Impact on other costs Outcomes (e.g Quality of Life Years (QALYs) for intervention Z

7. http://www.jrf.org.uk/publications/because-its-worth-it-practical- guide-conducting-economic-evaluations-social-welfare-fie

8. Many questions that economic research can address? The costs of inaction: What are the economic consequences of not supporting GOWD? The costs of action: What would it cost to intervene by providing a supportive measure ? The cost-effectiveness of action: What is the balance between what it costs to intervene and what would be achieved in terms of better outcomes, e.g. health status, improved functioning, independence, inclusion, quality of life, employment status? The levers for change: What economic incentives can encourage more use of those interventions that are thought to be cost- effective and less use of those interventions which are not?

9. Important to make economic case Policymakers interested in cost impact as well as effectiveness Do improvements in outcomes justify investment? But can be improved outcomes for greater investment Make case across sectors: impacts fall on many sectors, not just health / social welfare

10. What do we know about the economic costs and benefits of GOWD?

11. Costs and benefits of GOWD Many studies looking at the costs of living with disability Many studies looking at the costs of old age Limited studies looking specifically at the interface between the two Little focus on ‘benefit’, predominantly about cost

12. Health System Costs of Osteoarthritis of the Knee in Italy Leardini et al Clin Exp Rheumatol 2004 €934 per patient per year

13. Total Costs of Osteoarthritis of the Knee in Italy Total cost = €2170 per patient per year Leardini et al Clin Exp Rheumatol 2004

14. Employment, unemployment and inactivity among people with disabilities APPLICA & CESEP & EUROPEAN CENTRE 2007

15. Disability Benefits GB 2007 Source: Department of Work and Pensions, 2007 € 3.9 billion per annum Plus reduced tax receipts €14 billion

16. Projecting economic costs of disability and ageing MAP2030 http://www2.lse.ac.uk/LSEHealthAndSocialCare/MAP2030/

17. Projecting economic costs of disability and ageing MAP2030 http://www2.lse.ac.uk/LSEHealthAndSocialCare/MAP2030/

18. Projecting economic costs of disability and ageing MAP2030 http://www2.lse.ac.uk/LSEHealthAndSocialCare/MAP2030/

19. But….a need to know more about the positive social, emotional and economic benefits of postive ageing and disability

21. Economic Benefits of ‘Made in Manitoba’ Legislation http://www.gov.mb.ca/dio/discussionpaper/pdf/discussionpaper.pdf Economic benefits of Disability Access Legislation Highlighted

22. Economic Benefits of ‘Made in Manitoba’ Legislation Loyal, capable workforce Hiring and accommodating older workers and persons with disabilities to help in challenge of retaining skilled workers Increased incomes, increased tax revenues; reduced need for public support $1 billion per annum in consumer spending power. Eliminating barriers to employment / consumer services will expand figures and boost contribution of consumers to economy. Market for products for people with disabilities substantial – often goes beyond people with disabilities

23. Report for European Commission, DG Information and Society Looking at potential scope for action Including economic impact Kevin Cullen, Lutz Kubitschke, David Mc Daid, Peter Blanck, William N Myhill, Gerard Quinn, Patrick O Donoghue and Rune Halverson, 2008,

24. Making the economic case for the accessibility of ICT products and services to disabled and older people

25. Valuing the socio-economic contribution of older people in the UK (2011) In 2010 positive net contribution to UK economy £40 billion rising to £77 billion by 2030. Costs: takes account of pension, welfare, health costs. Benefits: Tax revenues, Consumer Spending, Provision of Care, Volunteering http://www.goldagepensioners.com/Uploads/PDF/main-report.pdf

26. Valuing the socio-economic contribution of older people in the UK (2011) http://www.goldagepensioners.com/Uploads/PDF/main-report.pdf

27. Economic value of benefits http://www.goldagepensioners.com/Uploads/PDF/economic-model-report.pdf Approach could be replicated in other settings; adapted to specific population sub-groups

29. http://www.myspace.com/kirkdouglas

30. A need to know more about economics and positive wellbeing for GOWD

31. The economic benefits of wellbeing Traditional focus on tackling disease. Health assumed to be ‘absence of illness’ Wellbeing goes beyond absence of illness Issues around mental and physical capital, social cohesiveness; altruism; innovation All of this has potential economic benefits

32. Wellbeing and satisfaction with life

33. To sum up Economics can help make case for investment in support for GOWD Research on costs of ageing/costs of disability, but less on interface or specific population groups Opportunities for research consideration of business case/case to public purse of GOWD more positively Opportunities to look at economic benefits of better wellbeing Opportunities for collaboration with economists