PLANNING FOR BALANCE OF CARE OF THE ELDERLY: A REJOINDER
| Published date | 01 November 1980 |
| Date | 01 November 1980 |
| DOI | http://doi.org/10.1111/j.1467-9485.1980.tb00934.x |
| Author | GAVIN H. MOONEY |
Scofrish
Journal
nf
Palrlicui
Economy,
Vol.
27,
No.
3,
November
1980
0
1980
Scottish
Economic
Society
502.00
PLANNING FOR BALANCE
OF
CARE OF
THE
ELDERLY:
A
REJOINDER
GAVIN
H.
MOONEY
Departments
of
Political Economy and Community Medicine,
University
of
Aberdeen
This rejoinder is intended to be couched in the same spirit as that
of
Knapp’s
comment (Knapp 1980) on my article in the
SJPE
on care
of
the elderly
(Mooney 1978).
Essentially Knapp appears not to be challenging the basis of the model
I
used but rather suggesting possible extensions of it. Of the three areas for
which he proposes such extensions-the measurement of output, the
computation and comparison of costs, and the measuring of “alternatives”
and “margins”-his most contentious comments are on the first.
I
believe,
largely because the objectives of care of the elderly appear
so
many and varied
and yet frequently ill-specified (perhaps not surprisingly), that the issue of
output measurement in care of the elderly remains much more problematical
than Knapp would have
us
believe. Essentially of course Knapp is right; it
is
“most important that we attempt
to
measure final
. .
.outputs ofcare services”.
The only real difference between us lies in our conceptions
of
the degree of
difficulty involved in doing
so.
On the issue of cost computations and comparisons Knapp asserts that
I
did not take “adequate account of the many factors which influence the costs
of care
within
a sector”. Certainly
a
cost function analysis might allow greater
account to be taken of such factors; but unless it were being hypothesised
that the nature
of
residential homes, for example, and/or their clients were
being radically altered (which it was not in the original article) it
is
difficult
to see the validity of this particular point.
On Knapp’s third area for comment, the meaning of alternatives and
margins, certainly it
is
possible to conceive of a continuum of care (as he
suggests). At the same time it seems most difficult to attempt to treat the
whole field
of
care of the elderly on such a continuum in a single manageable
model. There is however an argument for applying the balance
of
care model
to sub-sectors of the whole field-which would be a move in the direction of
Knapp’s continuum. Certainly too Knapp’s mention of the fact that the
flows
of
elderly patients between care locations is unidirectional is worthy of
emphasis and endorsement.
However, Knapp’s constructive conclusions are ones with which
I
can
only agree. The original model was primarily intended (as Knapp has
spotted) to demonstrate the usefulness of marginal analysis in planning for a
particular client group in the health care field. Knapp’s proposals for making
it a more valid, realistic and sensitive tool are to be welcomed.
Date
of
receipt
of
final
manuscript
:
18
April
1980.
295
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