Principles to organize disability services between market economy,

insurance mutuality, and a rights-based public response

Martin G. SchmollingerHeidelberg / Germanym.schmollinger@dvfr.de

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Deutsche Vereinigung fuer Rehabilitation(German Association for Rehabilitation...)Heidelberg / Germany

unites the “rehab family”:

• Disability movement

• Service providers

• Cost-carriers

• Social administration

• Rehab professionals

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Systemic aspects of rehabilitation service provision for disabled persons

• Public responsibility

• Solidarity, organized in (social) insurance

• Free evolution of a related social service market

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Specific features in Germany

• traditionally legal organization of social security

• extensive rehabilitation sector (various “players”)

• general belief in the benevolence of a free market

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Responsibility and utility

• being disabled implies private and public responsibility

• rehabilitees should codetermine their rehab process

• successful rehab should create a “win-win” situation for public and private life domains

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Economy of rehabilitation – 1 –

• rehabilitation costs money / gets more expensive with time

• expenditure awareness mustn’t ignore service quality!

• cost containment methods have to consider the positive (financial) returns of rehab services!

Rehabilitation pays off!

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Economy of rehabilitation – 2 –

• Basic principle: disabled persons have a right to rehabilitation

• Consequence: community’s responsibility to provide assistance, enable participation and contribution to the society

• Precondition for these principles to be realized: good governance

• Precondition as to the society: solidarity organized in widespread (social) insurance

• Precondition as to the “service business”: self-help ideas, civic commitment, professional expertise must merge into a social market

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Economy of rehabilitation – summary:

The three organization elements of a truly social setting for disability care…

• public response to existing requirements

• as large as possible a system of insurance mutuality, and

• a healthy private sector flexibly addressing actual needs

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Disadvantageous framework factors:

• stagnation of economic growth, increase of global population

• growing imbalance between “rich” private and “poor” public sector

• rise of average population age / morbidity (post-industrial countries)

• advancing singularization of people (post-industrial countries)

• decrease of community-building abilities ( “ “ )

• imbalance between existing human resources for social work and demand for them ( “ “ )

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Konrad Biesalski, 1910 – „What rehabilitation can do:

Caring for handicapped persons, especially those with initially

high treatment and assistance needs, is not a voluntary endeavor

but a requirement for the general public. If done in the right way,

rehabilitation enables to lead far more people into the core group

of society by letting receivers of public benefit develop into wage

earners and tax payers, by also opening more gainful work

options to family care persons, finally by reducing the burden of

long term benefit demands for individuals and society.”

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Further positive impacts of rehabilitation:

• … promotes national employment by creating qualified jobs

• … influences positively the shape of the world we live in

• … is a pathfinder for health prevention

• … helps people / institutions to better manage life’s risks

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Problem of excessive regulation – 1 – :

• clarifying / reshuffling responsibilities in the rehab sector

• ensuring more cooperation between the players

• strengthening consulting and information functions for p.w.d.

• introducing more elements of free-market economy

• redistributing financial and administrative resources within public authorities between the state and social insurance sector

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positive intentions:

Problem of excessive regulation – 2 – :

• expenditure restriction policy often endangers rehabilitation success

• free-market economy can be counterproductive in the social sector (standardized products for highly individual / special needs)

• flat-rate refinancing of service delivery wasn’t helpful in health work so far - see DRG: more frequently the allocation of measures is injust, added administration tasks, downgrading of quality performance especially in regard of complex (non-standard) treatments

• controlling: bureaucracy and overflowing documentation needs rob the helping professions of time indispensable for rehabilitation

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possible negative results:

Excursus: Assistive Technology - 1 -

• missing customer orientation in development and production

• insufficient compatibility with the surroundings of the user’s life

• lacking consumer affordability through over-complicatedness / excessive functions

• insufficient user acceptance and susceptibility to failures

• medically unspecific prescriptions permit improper sales strategies

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consequences of the “imperfect market”

Excursus: Assistive Technology - 2 -

• the user is not the paying customer

• experts for AT application do not co-operate with the retailers

• product competition and free market price development are missing

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reasons for deficient consumer satisfaction

... Information databanks are one key solution!

Prerequisites:

• information has to be set up as a system of multi-lingual data banks

• these have to cover any technical aids information available

• data banks have to be set up and operated by the user movement (consumers’ organizations)

• external expertise to be invited by the “consumer side”, as appropriate

• social administration / communities must finance all procedures

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Excursus: Assistive Technology - 3 -

The EASTIN project:

• detailed and comprehensive information on technical disability aids in all the main European languages

• e-portal for data bases targeting market validation and market transparency

• user controlled (EDF*supervised) and function based (in search)

• co-financed by the EU’s (European Union’s) Commissions for “Employment & Social Affairs” and “Information Society” _______ * European Disability Forum, 32 Square Ambiorix, B 1000 Brussels/Belgium

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European Assistive Technologies Information Network

Conclusion: principles for a good rehabilitation development

• rehabilitation has to be consumer-oriented

• access to rehabilitation must be an individual right

• there has to be public information available about rehab access

• user (co-)management of this information should be done by people with disabilities - in publicly paid jobs

• rehabilitation providers have to be open for evaluation of services by disabled people

• rehabilitation mainly organized by social insurance (for members), less by the state (for “grateful benefit recipients”) 18

Conclusion: principles for a better rehabilitation - 2 -

• private co-financing responsibilities of rehabilitation measures should be extremely limited

• rehabilitees should be empowered to self-manage personal budgets

• costly but successful rehab is better than cheap rehab without effect

• efficient disability care requires sufficient time for operative work and client-centred communication

• rehabilitation should not be left to the forces of the free market without public control and public user support

• economic rehabilitation principally means: effective and successful rehabilitation

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Thank you for your attention!

Deutsche Vereinigung für Rehabilitation e.V.Friedrich-Ebert-Anlage 969117 Heidelberg/Germany Heidelwww.dvfr.de