pdf [5.3MB] - Department of Families, Housing, Community Services

data from smaller partial datasets. Hence a top-down approach is generally applicable tocommunity and government programs, as well as health system expenditures. A bottom-upapproach generally applies in other cases. Whenever obtaining parameters required forimplementing the bottom-up approach, statistical analysis of datasets and a literature review(focussing on Australian literature but sometimes supplemented by international material) arepreferable.Uncertainty from data sources can be addressed by controlling for confounding factors orother problems where possible, and conducting sensitivity analysis on findings.2.3.1 HEALTH SYSTEM EXPENDITUREHealth system expenditure directed to treating conditions caused by NFF represents adiversion of resources that otherwise (in the absence of those health problems) could beused to produce other goods and services and hence optimise the social welfare function inthe Australian economy.Health system expenditure would be attributed to downstream health outcomes, in particularto the direct effects of resulting mental illnesses, substance abuse (drug and alcohol) as wellas suicide and self-harm. The Australian Institute of Health and Welfare (AIHW) produceshealth system expenditure costs that can be isolated to specific ICD-10 codes. The healthsystem expenditures cover all sources of funding within the health sector (federalgovernment, state government, private health insurer and out-of-pocket expenses). Theseexpenditures also incorporate a number of health system components such as: hospitalisation costs (inpatient and outpatient);out of hospital medical services (unreferred attendances, imaging, pathology, othermedical specialist services);pharmaceuticals (prescription and over the counter); andother health professionals.The AIHW produce these expenditure estimates by ICD-10 code, split by age and gender.These estimates of expenditure are relevant for the whole of the health sector (that is, theyhave not been siloed to one particular funding source). With this in mind, these healthsystem expenditures will need to be converted into a cost per case, using prevalenceestimates of the specific condition linked to FF. Evidence from the literature specifying theexpected levels of downstream health impacts (such as anxiety, depression, drug abuse,alcohol abuse and suicide) will need to show evidence of causation (as opposed tocorrelation). These aspects were previously discussed in Section 2.1 and Section 2.2.Health system expenditures can also be attributed to the occurrence of criminal activity.Mayhew (2003) estimate medical costs per crime for homicide offences ($7,600), assaultoffences ($200), sexual assault offences ($200) as well as robbery offences ($300). Thesehealth system expenditures could be applied (using a specific health cost inflation rate) topredicted crime events in future years linked to FF. This approach will be conservative as itdoes not include all sources of health system funding in its cost calculation. This approach isused in the estimations of second generational crime associated with child abuse andneglect in Taylor et al (2008).2.3.2 PRODUCTIVITY AND CARER COSTSBoth the productivity losses and informal carer costs represent less than optimal participationand employment in the labour force.38