Performance-based economic evaluation of child and family care interventions in two Finnish regional family centers

Abstract

Introduction: In Finland, the recent development of child and family care services has involved a move from curative services to promotive and preventive services provided by family centers. The aim of this study was to compare the effectiveness, costs, and cost-effectiveness of a multidisciplinary family center model and a decentralized child and family care services model. In addition, the study examined whether information included in client and patient information registers could be applied to the regular monitoring of performance in child and family care services Methods: A quasi-experimental case-control framework was conducted in two demographically similar Finnish municipal federations. Performance-based effectiveness was assessed by three indicators: 1) change in the number of psychiatric referrals 2) change in the number of corrective family work episodes and 3) enrolled duration of the intervention. Performance-based cost-effectiveness was analyzed by means of the incremental cost-effectiveness ratio (ICER) and graphical cost-effectiveness planes and cost-acceptability curves Results: Our results showed that during the interventions the multidisciplinary family center had less corrective family work episodes and established higher performance-based effectiveness in comparison to the provider of decentralized family care services. Cost-acceptability analysis suggested that performance-based cost-effectiveness in corrective family work was attained at a willingness to pay of EUR 300-350 per outcome unit. Despite of the lower amount of corrective family work, the duration of the interventions in the multidisciplinary family center was on the average 48 days longer than in the comparative organization Discussion and Conclusion: A model of service delivery focusing on preventive measures, responsiveness, duration of care episodes and clearly defined service processes supported the attainment of higher effectiveness and improved overall performance. It was also shown that existing client register data were applicable for monitoring cost-performance outcomes, and by inclusion of quality-of-life information would also be extendable to cost-effectiveness analysis of social services, such as family center services.