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Health Status Health Services Health Care Reform Diverse Communities of Women
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National Gender Economic Costing Group Lorraine Greaves and Olena Hankivsky, British Columbia Centre of Excellence for Women’s Health
This is an interdisciplinary research group led by Lorraine Greaves comprised of researchers with legal, economic, political science, sociology and policy perspectives. The group is developing a model and methodology for the gendered economic costing of various diseases, illnesses and experiences specifically related to women’s health. There has been a substantial amount of research conducted on the economic costs of various health issues and social problems such as substance abuse, smoking, gunshot wounds, AIDS, schizophrenia, cardiovascular disease and violence against women. However, a gender-sensitive approach to costing is not yet well developed. This means that many costs incurred by or on behalf of women may not be adequately measured. For example, home-care giving costs, which may result from early hospital release, deinstitutionalization or other aspects of health reform, may fall disproportionately on women. A full economic costing of home care would thus include not only the costs of unpaid work provided by women doing home care, but also the less direct costs that have both short- and long-term consequences. Examples of these may be labour force interruption, foreshortened careers, moving costs, or loss of pension and other benefits. Other categories of costs may included health care costs related to injuries, stress or depression. In general, such personal or individual/family costs often go unrecorded in economic costing models and need to be assessed in a gender-sensitive manner. This work builds on previous research costing violence against women and children to the health system, as well as assessing the costs to other segments of society, including individuals, providers of service and third parties such as employers and insurers. The current project is focussed on the methodological issues in economic costing, with a view to making economic costing both gender-sensitive and comprehensive. There are methodological debates in economic costing work, and varied approaches that can be taken. This project is identifying methods and approaches that take women’s experiences into account, and reflect adequately all of the varied costs associated with certain women’s health issues, services or conditions, both short and long term, direct and indirect. With the exception of economic costing of violence against women to the system, no gendered economic cost analyses have been undertaken in Canada. Secondly, the project will assess the ethical implications of economic costing and its various uses in policy analysis and development. Policy analysis and development derived from economic cost studies that do not take gender into account may lead to faulty assumptions, costly mistakes, inappropriate or incomplete services and unintended consequences. For example, Pharmacare policies that do not assess individual spending on alternative remedies and identify the gendered and cultural differences in such patterns are incomplete. Health reform measures that focus on hospital-based cost cutting or health system utilization reduction that do not assess the economic displacement costs of reform and restructuring are potentially very costly to individuals and families. Policies on home care that do not assess the gendered social and economic influences on care giving patterns are incomplete. Identifying and estimating these costs will add another dimension to policy development that is often missing. The work of the National Gender Economic Costing Group aims to redress these elements and eventually contribute to sharpening policy through its program of activities. Two background papers on methodological and ethical issues of such a model are under development during 2000. In 2001, the group will apply its model to several case studies in women’s health or services impacting on women in conjunction with other Centres of Excellence and other partners. Case examples such as the economic costs of home care giving, alternative therapies or midwifery will be pursued. Meanwhile, members of the group continue to work on economic costing projects related to other substantive areas such as violence and abuse of children and seniors. A related project under way at the British Columbia Centre of Excellence for Women’s Health project is estimating the Economic Costs Of Child Sexual Abuse in Canada, led by Olena Hankivsky. The study will provide preliminary national estimates of the direct and indirect costs attributable to child sexual abuse. Direct costs are being estimated from expenditures in four policy and program domains: Health, Social and Public Services, Justice, Education/Research and Employment. Indirect costs are being estimated using morbidity and mortality data from various national and provincial surveys. This study has a direct impact on women’s health in its estimates of the direct and indirect costs to individuals. The long-term effects of child sexual abuse on adult survivors (many of whom are women) include substance use, post-traumatic stress disorders, mental illness (especially depression) and sexual transmitted diseases. In addition, employment related costs affect both adult survivors and employers, often over the long term. This work builds on earlier work conducted by Greaves and Hankivsky on the costs of violence against women and children. Developing an estimate of the economic toll of child sexual abuse will have many benefits, including an improved understanding of the mental and physical health effects of this issue and the financial costs to governments, agencies, services and individuals. This project is supported by Health Canada’s Family Violence Initiative. The National Economic Gender Costing Group is funded for three years by the Social Sciences and Humanities Research Council’s Research Innovation Development Fund. For further information contact |
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