How can economics improve healthcare?

Case study: Development of a statewide model of grief and bereavement support services 

Everyone will experience grief and bereavement during their life, and their experience of it will be different. However, for a feasibility study of a model of grief and bereavement support services, it is necessary to identify the population impacted by grief and bereavement at any point in time. 

Identifying the target group 

Who would benefit from grief and bereavement support services? Research shows that most people receive information related to bereavement support from family and friends. Therefore, it would be beneficial to have information available and centrally accessible to the general population. Additionally, approximately 60 per cent of people seek bereavement support from primary care available in the community, and in comparison, 10 per cent would develop complex needs and require specialist support. Research shows that for every death, five people are bereaved. This includes carers, family and friends, with sole carers and spouses being more prone to needing primary or specialist support.

An inclusive model of care 

The overarching goal was to develop a model of care that would serve everyone regardless of their location and context. We collaborated with university researchers to design the model and its key components, which included: 

• Establishing an information and navigation support service 
• Promoting grief education 
• Establishing access pathways 
• Forming partnerships/linkages. 

The model was tested at a stakeholder forum to identify outcomes it should achieve if it were operational. Two key outcomes identified were: 

1. Increased grief literacy
2. Accessibility to information and support services.

Estimating the workforce that would service this proposed model of grief and bereavement services was challenging yet crucial, as it would contribute to a high proportion of its cost. In the absence of demand modelling, we based our estimates on similar programs that are already in place.

Linking program outcomes to economic benefits 

The identified outcomes could lead to improved decisions about service use, use of time and mental and physical health for the family and friends of the deceased person at an individual level. The economic benefits to family, friends and carers could be noticed through improved wellbeing, improved death literacy, avoided productivity loss due to fewer days off at work, and avoided acute medical and healthcare costs.

Health services could be better equipped to make more timely and appropriate referrals at the health system level. The economic benefits to the healthcare system could be seen in the lower costs to the public healthcare system such as hospital stays, emergency department visits, GP visits, use of patient transport services, etc. It was not possible to quantify all these benefits, so we emphasised case studies and listening to stakeholder stories to describe benefits qualitatively.

Economic analysis

Once we estimated the costs and benefits of a model of grief and bereavement services, we undertook a Rapid CBA. This type of analysis is performed for feasibility studies to assess the initial viability of a project, before a more comprehensive CBA is done closer to an investment decision. Benefits from the model included: 

• Cost savings to the healthcare system by diverting people away from more expensive healthcare services such as hospital stays and ED visits 
• Cost savings to individuals from lower out-of-pocket expenses on non-hospital Medicare services such as GP visits 
• Cost savings to individuals from feeling less lonely, which in turn leads to less harm caused by smoking and alcohol consumption 
• Productivity gain from fewer days off-work, lower presenteeism, and less time off unpaid work for carers as well as family and friends of carers. 

For this model to be viable, the CBA was required to return a positive Net Present Value, which is the current value of all future benefits minus costs, and a benefit-cost ratio exceeding one, indicating that one dollar invested in this model would yield more than one dollar in return to the community. 

Key findings 

Two key findings of the CBA were: 

1. The magnitude of non-market benefits (e.g. cost savings from improved productivity) from such a model far exceeds the benefits that can have a market value (e.g. hospital avoidance).
2. There are clear advantages from investing in a statewide model, compared to a local or countrywide model.

This case study exemplifies the critical role economics plays in healthcare service delivery.