Economic Evaluation of Models of
Community Services: A Critique of
Applications of the Concept
The terms of the grant under which this project was funded required an economic review of community health services. The federal government had been trying to encourage that more emphasis be placed on community care since 1977, when a special grant was included in the Established Programs Financing Act (EPF) package to promote home care. It was argued by some politicians and bureaucrats that community care would not be less expensive than institutional care. The request for this chapter to be included was to provide some proof of this controversial area. This chapter was written by Christine Gordon in 1991.
Economic evaluation of alternative health delivery modalities must be seen in terms of the goals set for the evaluation process. These may range from the most narrow — cost containment — to the broadest concept of health promotion in the sense of the World Health Organization (WHO) definition. Evans and Stoddart (1990) express reservations about the usefulness of the latter approach:
Such a comprehensive concept of health, however, risks becoming the proper objective for, and is certainly affected by, all human activity. There is not room for a separately identifiable realm of specifically health-oriented activity. The WHO definition is thus difficult to use as the basis for health policy, because implicitly it includes all policy as health policy. It has accordingly been honoured in repetition, but rarely in application. (p. 3)