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Is rehabilitation a short run cost or a long term social investment with an extreme high rate of return?. 2011-05-13 Ingvar Nilsson ( [email protected] ). - PowerPoint PPT Presentation
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Is rehabilitation a short run cost or a long term social investment with an extreme high rate of
return?
2011-05-13
Ingvar Nilsson ([email protected])
”When I leave prison with a plastic bag with all my
belongings in one hand, a few dollars in my pocket . No social
contacts outside the drug community, no job, no housing,
no incomeHow long do you think I will
manage”?
A mathematical summury
0 1 0 1 1
( )
(1 ) (1 )
där enheter inom aktör ex Psykiatri inom Landsting insats/aktivitet (i=1...m) inom viss enhet priset/kostnaden för
kt it aiT B T B Ibj bj bk
j t tt b t b i
TC a pTC
r r
bap e
Some statements• Drug addiction is expensive, very
expensive
• You can put a price on it– Most of the costs are invisible
• You can calculate the economic benefits of– Prevention– Rehabilitation
An economist´s point of view
• An economist is a person who know the price of everything and the vaule of nothing
• On the other hand
• Money talks!!!
IT ALL STARTED 32 YEARS AGO
How much does drug addiction cost
the Swedish society?
IT ALL STARTED 32 YEARS AGO
IT´S TOO EXPENSIVE
IT´S TOO EXPENSIVE!!!
BUT WHAT IS TOO EXPENSIVE???
Socioeconomic accounting
The economics of marginalization
make visible the long run economic effects of
marginalization
in order tosee the benefits of prevention
and rehabilitation
Euros & kronor
• 1 EURO = 10 KRONOR
• The figures are swedish
• The principles are universal
• The method is translatable
InterventionPrevention
Rehabilitation
Non interventionBussinesas usual
The basic choice
Questions to ask
• What does addiction cost
• What are the economic effects of prevention and rehabilitation
• What are the rates of success?
• How succesful do you have to be in order to be profitable?
Let´s start with some resultas
then look at the methodology
Employ-ment Service
Enter-prise
Social Insurance Adm.
Munici-pality
County Council
Legal System Other Total
Amphetamine addict, male21 278 0 67 833 192 833 53 400 534 890 800 000 1 670 235Amphetamine addict, female29 500 0 146 000 389 917 58 667 523 430 266 667 1 414 180Heroin addict, male 32 056 0 77 167 138 500 66 567 945 853 720 000 1 980 143Heroin addict, female 26 667 0 164 333 385 667 75 300 601 185 373 333 1 626 485Alcoholic, male 19 667 0 98 333 191 000 115 167 184 583 26 667 635 417Alcoholic, female 38 667 0 125 000 228 500 93 000 87 015 0 572 182
The price tag of business as usualAnual costs
The metadone program in Stockholm
• 600 clients• Annual cost 63 Mkr• Annual cost/client approx 100.000 Kr• Levels of succes
– No succes at all
– Partially free from crugs, still criminal
– Partially free from drugs, no criminality
– Free from drugs, no job
– Free from drugs, job
• Question; is this a profitable project?
Summa VinstVinst / klient
Intäkt 18 263 520Kostnad 13 697 640Intäkt 63 000 000Kostnad 63 000 000Intäkt 61 990 000Kostnad 36 450 300Intäkt 127 590 000Kostnad 41 827 567Intäkt 91 912 000Kostnad 69 949 617Intäkt 511 471 700Kostnad 48 297 059Intäkt 495 600 000Kostnad 43 456 000Intäkt 1 369 827 220Kostnad 253 678 182
452 144 000 753 573
1 116 149 038 1 860 248
21 962 383 36 604
463 174 641 771 958
25 539 700 42 566
85 762 433 142 937
4 565 880 7 610
0 0
Landstinget
Rättsväsendet
Övriga
Totalt
Arbetsförmedling
Programmet
Försäkringskassan
Kommunen
SOCIOECONOMIC ANUAL INCOME STATEMENT METHADONE PROGRAM 600 CLIENTS
PROFIT PROFITPER PERSON
Costs63 Mkr
Revenues1.116 Mkr
AnualRate of return
17 times
Ackumulerad vinst och intern kostnad
0
2 000 000 000
4 000 000 000
6 000 000 000
8 000 000 000
10 000 000 000
12 000 000 000
14 000 000 000
16 000 000 000
18 000 000 000
20 000 000 000
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20
År
Kr Vinst
Intern kostnad
Total profit for a period of 20 years, SEK
If you could reinvest the profits!!!Ackumulerade vinster investerade i Metadonprogram
0
2 000
4 000
6 000
8 000
10 000
12 000
14 000
16 000
1 2 3 4 5 6 7 8 9 10 11 12
År
An
tal
hero
inis
ter
0
5
10
15
20
25
30
An
tal
Meta
do
np
rog
ram
Antal program Antal heroinister
20 yearswith metadon
1 krona
20 yearswith addiction
151 kronor
Rate of return for the Success stories
THE PREVENTIVE PERSPECTIVE
The road to hell....
When does it start???
Normally very early!!!
0
20 000
40 000
60 000
80 000
100 000
120 000
140 000
160 000
180 000
WorstCase BestCase
ADHD genomsnittskostnad
Övriga
Rättsväsendet
Landsting
Kommun
Försäkringskassan
www.seeab.sewww.socioekonomi.se
ADHD – average annual cost 1-19 years
0
20 000
40 000
60 000
80 000
100 000
120 000
140 000
160 000
180 000
WorstCase BestCase
ADHD genomsnittskostnad
Övriga
Rättsväsendet
Landsting
Kommun
Försäkringskassan
www.seeab.sewww.socioekonomi.se
NO lack of resources But how do we use them?
0
100 000
200 000
300 000
400 000
500 000
600 000
700 000
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
KrÅlder
ADHD Best Case
Övriga
Rättsväsendet
Landsting
Kommun
Försäkringskassan0
100 000
200 000
300 000
400 000
500 000
600 000
700 000
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Kr
Ålder
ADHD Worst Case
Övriga
Rättsväsendet
Landsting
Kommun
Försäkringskassan
ADHD best case & worst case Costs year 1-19
PreventionEarly
Low cost
Non- preventionLate
High cost
0
100 000
200 000
300 000
400 000
500 000
600 000
700 000
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
KrÅlder
ADHD Best Case
Övriga
Rättsväsendet
Landsting
Kommun
Försäkringskassan0
100 000
200 000
300 000
400 000
500 000
600 000
700 000
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19
Kr
Ålder
ADHD Worst Case
Övriga
Rättsväsendet
Landsting
Kommun
Försäkringskassan
Nobody sees the whole pattern Nobody sees the long term effects
PreventionEarly
Low cost
Non- preventionLate
High cost
The situation at the age of 33
the non - intervention perspective
1 5 10 15 20 25 40Arbetsförmedling 800 010 3 703 962 6 748 350 9 250 614 11 307 293 12 997 733 16 467 794Försäkringskassan 2 175 000 10 070 022 18 346 846 25 149 792 30 741 318 35 337 145 44 771 255Kommunen 4 970 000 23 010 579 41 923 598 57 468 721 70 245 679 80 747 407 102 304 890Landstinget 3 059 500 14 165 164 25 807 897 35 377 375 43 242 788 49 707 584 62 978 231Rättsväsendet 22 361 150 103 529 782 188 623 715 258 564 726 316 051 139 363 300 780 460 292 753Övriga 25 200 000 116 673 360 212 570 357 291 390 698 356 175 273 409 423 471 518 729 018Summa 58 565 660 271 152 870 494 020 763 677 201 926 827 763 489 951 514 119 1 205 543 940
30 ADHD GROWN UP´SCRIMINAL AND DRUG ADDICTION
BENEFITS AND COSTS FROMPREVENTION
& REHABILITATION
BENEFITS AND COST FROM
LACK OF PREVENTION& REHABILITATION
IS REALLY AN OUNCE OF PREVENTIONWORTH MORE THAN A POUND OF CURE?
TID
COST
INVESTMENT COSTSADHD-PROJECT, 3 MILLIONS
PROBABLE REHAB PROFIT250 MILLIONS
PROFIT FROM PREVENTION OR REHABILITATION AND
THE TIME FACTOR
COUNSELLOR FOR 40.000SCHOOL CHILDREN
THE ECONOMICCOSTS FOR
ONE DRUG ADDICT
WHAT DO i GET FOR THE MONEY?ADDICTION VS COUNSELLOR IN SCHOOL
Three paths to follow
• Stop looking at the top of the iceberg – start looking from a holistic point of view
• Stop thinking short term costs – start thinking long run social investment
• Stop thinking ”not my table” - start thinking about mutual cooperation
So how did we make this calculations???
BASTA – a social enterprise• 1991 – I have seen the light - St Patrigiano• 1994 start• 60 former addicts (mostly ”street level”)• 30-50 years old, 15-25 years as outsiders• A democratic company• Rehabilitation through ”good work”• Steady growth• Economically & socially succesfull• Developed working relations with local
authorites
Peter managing partner at Basta, former addict for 20
years; are we a profitable company???
The socioeconomic perspective
• An expansion of the perspective of business economics and agency economics
• All relevant impacts must be considered– An expression of the overall view
• Three steps– Identify– Quantify– Assess
Three aspects of the socioeconomic report
• Income statement– Revenues minus costs– Difference between public and business perspectives– Difference between tunnel vision and overall view
• Investment calculation– What happens long-term– A short-term cost may be a long-term investment– A social investment perspective
• Key figures statement – What happens if we compare
People with addictions
Somatic care
Psychiatriccare
Dependencycare
Addictioncare
Support
Social life & contextFamily & social network
Housing
Employment
DOCTORNURSE
MENTAL HEALTH WORKEROCC. THERAPIST
COUNSELLOR
PHYSIOTHERAPIST
DISTRICT NURSE
DOCTOR
PSYCHOLOGIST
PSYCHOTHERAPIST
HOUSING SUPPORT
MANAGE HOUSING
AID ASSESSMENT
NURSE
RESIDENTIALTREATMENTCENTRE
HOUSING COMPANY
CASEWORKER SOC. INS.
SOCIAL WORKER IFO
EMP. SERVICE COUNSELLOR
CUSTODIAN
TRUSTEE
BAILIFF
DEBT COUNSELLOR
GUIDANCE EMP
OSA GUIDANCE
VOCATIONAL GUIDANCE
GUIDANCE COUNSELLOR
ALCOHOL THERAPIST
NURSE, DETOX
TREAT-MENTCENTRE HOUSING SUPPORT
HOME HELP
SOCIAL WORKER
SOC CHILD/ADOLESCENTCHILDPSYCHIATRY
POLICE
INDIVIDUAL/FAMILY SERVICES
RSMH
PO
HOME VISITS
Prison &ProbationService
CORRECTIONALOFFICER
COUNSELLOR
POLICE
JUDGE
PROSECUTOR
ATTORNEY
Burglary
Car theft
Shoplifting
Police investigation
Claims adjustment
Loss of property
Property damage
Time/Prod lossvictims
Apprehension
Fraud
Receivingstolen goods
Peddling (drugs/alcohol)
Smuggling
Prostitution
ChainCrime
What does the drug really cost?
Sources of income
Public impacts of burglary and theft (Figures in SEK)
One burglary
Annual burglary, one person
Annual burglary, 60 people
Victim 2,000 150,000 9,000,000
Police 500 37,500 2,250,000
Insurance company 14,000 1,050,000 63,000,000
Total 16,500 1,237,500 74,250,000
Theft – stolen goods – dealer process200 kr to the dealer for amfetamin
Suspended sentence
Contract treatment
Community service
Probation
Minimum security (open)local prison
Minimum security (open)national prison
Locked local prison
Locked national prison
High security prison
Intensive supervision
Conviction
Main proceedings
Detention order proceedings
Attorney
Crime
Apprehension
Detention
Prosecutor
Detention
Preliminary investigation/Criminal investigation
Personal case study
Counsel forInjured party
Appeal
Arrest
Indictment
Court of appeal
For
ensi
c ps
ychi
atric
exam
inat
ion
Detention
PPS TransportRemandprison
InvestigationQuestioning
Dismissed
Released
Supervision
Supervision-Board Drug adiction
and the legal system
Investigation Sickness compensation
Sickness benefit
Rehab-compensation
Investigation
Poorfinances Investigation Economic
assistance
Nojob
Unemploymentbenefit
Activitycompensation
Public sheltered compensation (OSA)
Wage subsidy
Investigation
Waiting periods
Doctor
Illness
Illegal
Paid work Production value
Legal
Tax revenues
Drug adiction and financial support
Peter once more; are there not many people getting a job from my criminality and drug
addiction?
Addicts at Vägen Ut and Basta as indirect employers
Basta VägenUt Samtliga Basta VägenUt SamtligaRättsväsendet 0.96 0.71 0.87 62 27 89Kommun/Landsting 0.77 0.85 0.80 50 32 83Övrigsektorn 0.68 0.46 0.60 44 17 62Summa 2.4 2.0 2.3 157 77 234
Per Individ Hela FöretagetPer Person Enterprise
Total Total
Total
Legal system
Other sector
Municipality/County Council
26.000 ADICTS IN SWEDEN, EVERY ONE CREATES 2.3 FULL TIME JOBS
THIS GIVES A TOTAL NUMBER OF 59.800 FULL TIME JOBSOR MORE THAN 1% OF THE LABOUR FORCE
Is there a drug industrial complex????
Investigation Sickness compensation
Sickness benefit Rehab
compensation Investigation
Poor finances
No job
Unemployment benefit Activity compensation Sheltered Public Employment (OSA)
Wage subsidy
Investigation
Waiting period
Doctor
Illness
Illegal Paid work Production value
Legal
Means of support
Income
Tax revenues
Receivers of stolen goods
Supervision
Suspended sentence Contract treatment Community service
Probation Minimum security (open) local prison
Minimum security (open) national prison
Locked local prison Locked national prison
High security prison
Intensive supervision Conviction
Main proceedings
Remand prison Protective custody
Detention Detention order proceedings
Attorney
Apprehension Detention
Investigation Prosecutor Dormant
Indictment Arrest Detention Criminal investigation Personal case study
Other expenses
VAT revenues
Addiction
Medicine Detoxification
Methadone Subitex
Antabuse
Psychiatric emergency
Outpatient psychiatric care Inpatient psychiatric care
Dependency Abstinence
Physical effects
Psychiatric Psychiatric symptoms
Mental effects of addiction
Doctor visit local clinic Medical care day
Medicine Emergency care
Minor operation
Major operation
Dental emergency
Medical Heroin addict Hepatitis X Infections
.... Surgical
Amphetamine addict Assault
Road accident Accident .......
Physical effects of addiction
Odontological
LVU
Contact person Foster home/Treatment Foster home/Traditional
Advance benefit Support resource Child-care
Decision
County Admin. Court
Appeal, Admin. Court of Appeal
Attorney
Decision on case
Case investigation home
Case
Report
Maternity clinic Paediatric clinic
Child-care School
Emergency foster home Immediate
care order
School nurse School social worker
Social services
Police Support resources
Investigation At-risk child
Special Educator Support Teacher Investigation Homeless
Housing subsidy Social contract/ trial housing Residential care home
Board and lodging Homeless shelter Supportive housing Hotel housing
Apprehension, Indictment, Conviction and Punishment
Child
Housing
Care/T
reatm
en
t
Burglary
Car theft
Shoplifting
Police investigagtion Claims adjustment
Property loss Property damage Time/Prod. loss
victims Apprehension
Fraud
Drug peddling Smuggling Prostitution
Investigation
Report
Case
Decision on case
Investigation
Continual contact
Decision
County Admin. Court
Attorney
Dependency clinic
Outpatient care
Housing Board and lodging Contact person Treatment centre
LVM home
Economic assistance
Short term foster home Emergency foster home Child/Adolescent Psychiatry
Support resource School
Child/Adolescent Psychiatry
Appeal, Admin. Court of Appeal
Investigation
Costs for drug adiction
the full picture?
Employ-ment Service
Enter-prise
Social Insurance Adm.
Munici-pality
County Council
Legal System Other Total
Amphetamine addict, male21 278 0 67 833 192 833 53 400 534 890 800 000 1 670 235Amphetamine addict, female29 500 0 146 000 389 917 58 667 523 430 266 667 1 414 180Heroin addict, male 32 056 0 77 167 138 500 66 567 945 853 720 000 1 980 143Heroin addict, female 26 667 0 164 333 385 667 75 300 601 185 373 333 1 626 485Alcoholic, male 19 667 0 98 333 191 000 115 167 184 583 26 667 635 417Alcoholic, female 38 667 0 125 000 228 500 93 000 87 015 0 572 182
The price tag of business as usual
26.000 adicts - annual costs around 40.000 millions kronor
Arbets-förmedling Företaget
Försäkrings-kassan Kommunen Landstinget
Rätts-väsendet Övriga Summa Vinst Vinst/Individ
Arbetsförmedling Intäkt 1 590 511 1 590 511Kostnad 0 0 1 590 511 24 469
Företaget Intäkt 5 000 000 5 000 000 2 000 000 6 000 000 18 000 000Kostnad 16 500 000 16 500 000 1 500 000 23 077
Försäkringskassan Intäkt 6 032 500 6 032 500Kostnad 1 566 000 1 566 000 4 466 500 68 715
Kommunen Intäkt 15 321 500 15 321 500Kostnad 6 716 000 6 716 000 8 605 500 132 392
Landstinget Intäkt 4 152 667 4 152 667Kostnad 2 180 500 2 180 500 1 972 167 30 341
Rättsväsendet Intäkt 34 716 722 34 716 722Kostnad 2 161 500 2 161 500 32 555 222 500 850
Övriga Intäkt 36 906 667 36 906 667Kostnad 6 000 000 6 000 000 30 906 667 475 487
Totalt Intäkt 116 720 566Kostnad 35 124 000 81 596 566 1 255 332
SOCIOECONOMIC REPORT, INCOME STATEMENT, BASTA 2005
Perceived 1,5 Mkr
Total
81.5 Mkr
Basta Anual
Rate of return
54 times
Socioeconomic report, Basta, 2005. Payoff time for rehab investment
ActorPayoff ratio Payoff time
Municipality 1/0.82 1.22 years = 1 year 3 months
Public 1/6.25 0.16 years = 2 months
Socioeconomic report, Basta, 2005
Five-year return on a rehab place
Cost of rehab
Revenue to municipality, SEK
Return to municipality, %
Revenue to the public, SEK
Return to the public, %
285,000 1,175,000 413% 8,900,000 3,120 %
Three important short comings
• The lack of holism– The tunnel vision syndrome
• The lack of long term thinking and acting– The short term syndrome
• The existence of viscious circles– The causality of costs and benefits is circular
People with addictions
Somatic care
Psychiatriccare
Dependencycare
Addictioncare
Support
Social life & contextFamily & social network
Housing
Employment
DOCTORNURSE
MENTAL HEALTH WORKEROCC. THERAPIST
COUNSELLOR
PHYSIOTHERAPIST
DISTRICT NURSE
DOCTOR
PSYCHOLOGIST
PSYCHOTHERAPIST
HOUSING SUPPORT
MANAGE HOUSING
AID ASSESSMENT
NURSE
RESIDENTIALTREATMENTCENTRE
HOUSING COMPANY
CASEWORKER SOC. INS.
SOCIAL WORKER IFO
EMP. SERVICE COUNSELLOR
CUSTODIAN
TRUSTEE
BAILIFF
DEBT COUNSELLOR
GUIDANCE EMP
OSA GUIDANCE
VOCATIONAL GUIDANCE
GUIDANCE COUNSELLOR
ALCOHOL THERAPIST
NURSE, DETOX
TREAT-MENTCENTRE HOUSING SUPPORT
HOME HELP
SOCIAL WORKER
SOC CHILD/ADOLESCENTCHILDPSYCHIATRY
POLICE
INDIVIDUAL/FAMILY SERVICES
RSMH
PO
HOME VISITS
Prison &ProbationService
CORRECTIONALOFFICER
COUNSELLOR
POLICE
JUDGE
PROSECUTOR
ATTORNEY
TID
COST
INVESTMENT COSTSADHD-PROJECT, 3 MILLIONS
PROBABLE REHAB PROFIT250 MILLIONS
PROFIT FROM PREVENTION OR REHABILITATION AND
THE TIME FACTOR
SHORT-TERMCERTAIN
COSTS OF REHABILITATION
LONG-TERMUNCERTAIN
PROFITS RESULTING FROMSUCCESSFUL PREVENTION
OR REHABILITATION
COST DRIVING VICIOUS CIRCLES
Lack of money
Cut down in prevention
& rehab
Budget inbalance
Social marginalisationExlusion
Social ”repair”
costs
Costs Care
HealthRepression
Support
CONCLUSIONS: RESULTS
• The public profit is very high at SEK 1 million per employee/year• The public profit is 50 times higher than business profit• The legal system, social services and insurance companies
gain the most• The long-term profits are extremely high• As social investment projects, the enterprise generates annual
returns of several hundred percent• After five years with the enterprise, the public profit can amount
to SEK 9 million per employee• The total public profit for the enterprise amounts to about SEK
80 million per year
• www.seeab.se www.socioekonomi.se
CURRENT SITUATION
• We have vast resources in our public systems
• We are using a substantial portion of these resources inefficiently
• People are suffering and the public is wasting its resources
• The suffering and waste are unnecessarywww.seeab.se
IT CAN BE FIXED
• We can develop knowledge on the impacts of marginalisation
• We can calculate the costs of exclusion and the value of rehabilitation
• That makes it possible to form a picture of the economic value of prevention and rehabilitation
• But it is going to take a great deal of work to get there in reality
