Transcript 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
Barbados’ Contribution to the Cost Study
The NCSA (Barbados) conducted three (3) separate
studies. 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).
Estimating Direct
Government Expenditure
on Drug Demand
Reduction in Barbados
(EDGE)
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.
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.
Table 1
Estimates of Total Government
Expenditure on Demand Reduction
Year
Institution
1996
1997
1998
1999
2000
$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
NCSA
Figure 1
Estimate of Total Government
Expenditure on Demand Reduction
Estimate of Total Government Expenditure on Demand
Reduction
$6,000,000.00
$5,000,000.00
$4,000,000.00
$3,000,000.00
$2,000,000.00
$1,000,000.00
$0.00
1996
1997
1998
1999
2000
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.
Analysis of EDGE Study
A standardised data collection instrument
for all health-care providers.
Central depository for studies of this type
will be needed.
Survey of
Emergency Rooms in
Barbados
(The ER Study)
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..
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.
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
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.
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
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.
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.
The Estimation of Costs
Attributable to Substance Abuse
and Loss of Productivity
for Inmates at
Glendairy Prison in Barbados
(The Prison Study)
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
Methodology
A random stratified sample among non-
remand inmates;
150 inmates were chosen;
The actual sample size was 140 inmates
(93%)
Stratified Sample
Type
of
crimes
Other
RTO
Damage
Robbery
Theft
Burglary
Firearms
Sexual
crimes
Drug
crime
Violent
crimes
Total
Nonremand
52
12
12
59
133
68
68
57
200
166
817
Percent
6%
1%
1%
7%
16%
8%
8%
7%
24%
20%
100
Sample
9
2
2
11
24
12
12
10
37
30
150
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:
Economic Loss Due to Drugrelated Crimes
The formula
Cost of incarceration
+
Loss of productivity cost
Economic cost of a prisoner
(Perez et al 2004)
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.
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.
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
INMATE
ID
MOUTHS
IN PRISON
NO. OF
CONVICTIONS
LENGTH OF
SENTENCE
(MTHS)
TOTAL COST
PER DAY
DAILY
COST
WAGES
PER MTH
COST IN
PRISON
ECONOMIC
LOSS
1
9
1
18
$8,662.23
$33.97
$6,192.86
$17,120.64
$23,313.50
2
39
1
60
$36,150.75
$33.26
$26,398.57
$55,872.36
$82,270.93
3
9
1
18
$8,356.50
$33.97
$5,974.29
$17,120.64
$23,094.92
4
49
1
180
$45,241.36
$32.97
$33,320.00
$166,192.75
$199,512.75
5
13
1
36
$12,578.01
$33.81
$9,034.29
$34,082.36
$43,116.64
6
16
1
36
$15,253.31
$33.75
$10,977.14
$34,016.22
$44,993.36
7
28
1
60
$25,807.10
$33.52
$18,700.00
$56,306.39
$75,006.39
8
7
1
30
$6,488.18
$33.97
$4,638.57
$28,534.40
$33,172.97
9
7
1
24
$7,031.69
$33.97
$5,027.14
$22,827.52
$27,854.66
10
49
1
180
$45,241.36
$32.97
$33,320.00
$166,192.75
$199,512.75
11
5
1
60
$4,517.95
$33.97
$3,230.00
$57,068.80
$60,298.80
12
8
1
132
$7,439.33
$33.97
$5,318.57
$125,551.35
$130,869.92
13
8
1
60
$7,677.11
$33.97
$5,488.57
$57,068.80
$62,557.37
14
48
1
60
$44,547.55
$33.02
$32,761.43
$55,478.05
$88,239.48
15
49
1
300
$45,241.36
$32.97
$33,320.00
$276,987.92
$310,307.92
16
16
1
48
$14,651.36
$33.76
$10,540.00
$45,371.97
$55,911.97
17
7
1
60
$6,997.72
$33.97
$5,002.86
$57,068.80
$62,071.65
18
26
1
60
$24,524.69
$33.55
$17,752.86
$56,363.18
$74,116.03
19
9
1
60
$8,662.23
$33.97
$6,192.86
$57,068.80
$63,261.65
TOTAL
$375,069.78
$639.31
$273,190.00
$1,386,293.69
$1,659,483.69
MEAN
$19,740.51
$33.65
$14,378.42
$72,962.83
$87,341.25
Analysis Prison Study
The formula is unclear as outlined below:
– Number of Convictions vs. Total sentences:
– Length of Sentence:
Analysis Prison Study Cont’d
A systematic database of prison records
which includes
–
–
–
–
reason for incarceration,
length of sentence,
profession and
average income.
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.
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.
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.
What is therefore needed is a bridging of
government and cost study estimates which
will allow for more robust costs estimations.
Discussion