How does care management improve efficiency? The effects of case management inputs on the productivities of home care services

<p>The paper has three aims. <li>The first is to state a formal theory embodying one perspective on how care management inputs affect efficiency - in effect, one component of the 'economic theory' of care management.</li><li>The second is to test some of the hypotheses in the theory in the light of some American and some British evidence, in doing so reevaluating the reasons for partial success of the leading American case management experiment, and describing the properties of some British care management perspectives frorn this perspective.</li><li>The third is to show the helpfulness of the theoretical structure in implementing care management arrangements in the UK. </li>

<p><p><p>A theoretical logic is stated, and two methods of testing and estimating the relationships presented. One method is applied to the data for 427 persons and 25,449 person-months of the US long-term care channeling project. The other is applied to data about costs, needs and outcomes for two implementations of the PSSRU Thanet (Kent Community Care Project) model in Sheppey and Tonbridge.

<p><p><p>The results show there to be the predicted indirect as well as direct effects on outcomes of variations in case management inputs. They illustrate the importance of stating the logics of care management more precise, and of matching the analysis of evidence precisely to them. They show that introducing case management into a fragmented system like that in the US can achieve results which fall far short of the most efficient production of outcomes even if the case management is carefully introduced and the model designs are in important respects carefully constructed from the best contemporary argument.