Implications of unmet need (UM), welfare gains [G), and gain/cost (G/C) bases for targeting criteria

<p>British community care reform logic embodies (i) developing and deliberately targeting home care as a whole, and (ii) applying the care management approach [CMA], with intensive (preferably budget- devolved) care management [ICM] for some.

<p>(i) The relations between resources needs and outcomes requires that good targeting policy explicitly faces more difficult dilemmas: more subtle value-based choices and circumstances than is now typical. The paper distinguishes maximising 'welfare gain' [WG] (ratio of 'benefits' to 'costs') from the logically inferior maximally reducing unmet needs for help with personal and instrumental activities of daily living [UM]. Applying either requires the weighting of narrower goals.

<p><p><p>(ii) Authorities must balance the general application of CMA and the development of ICM teams, ultimately with devolved<p><p>budgets. DH reports show that authorities have attempted to provide ICM to too many, and discuss targeting criteria for it.

<p><p><p>After setting the context, the paper uses the data from the Kent Community Care Project and its three replications of budget-holding ICM to model what the implications of various targeting criteria based on WC for CM and other inputs separately, taking into account how CM inputs affect the productivities of the others.