Quality and cost

Determining the expected costs of providing social care services as part of budgeting for social protection is becoming an issue of increasing importance for governments and donors, especially in country contexts where social care services are just beginning to be developed, where a shift needs to take place from one predominant model of care to another or where services are being expanded to provide a continuum of service provision. The answer is rarely straightforward and is linked to a number of factors including the particular needs of vulnerable groups in a given country or locality, the range of services to be provided, the way in which they are organised and the standard to which they should be delivered.

There are a number of different approaches to the development and application of standards but those standards that set minimum structural and functional requirements are likely to be of greatest importance in determining costs of services. An example of a structural standard might be the requirement for a day care centre to be located in a particular location; an example of a functional standard might be the minimum time frame within which an assessment or case review needs to take place after a service user makes contact with a service provider. These structural and functional standards should not be confused with (and do not replace) good practice guidelines, codes of conduct or targets and objectives that need to be set as part of individual person-centred care plans.

Once core standards have been determined and a service specification clearly articulated, unit costs for capital, fixed and variable expenditures can also be identified and these, provide a solid foundation for determining the direct costs of a particular service. Of course, when a government is commissioning services, this calculation alone does not reflect the real cost of providing a service. The ‘overhead’ costs, incurred by the commissioner and other nominated agencies, in carrying out management, administrative and quality assurance functions also need to be factored in and apportioned.