<p>The general purpose of this dissertation is to evaluate KrAmi – a correctional program for young offenders – regarding socioeconomic profitability. Evaluating socioeconomic results enables us to examine and reflect upon the possibilities of applying socioeconomic models to social work. The basic data, from a long-term follow up study of 140 persons in two KrAmi programs, one Knuff program and two probation programs (treatment as usual), also allow systematic comparisons with more traditional evaluation models</p><p>The data have been presented in one research report and three articles.</p><p>The research report examines both the effects in an effect study and the socioeconomic results in a CBA (Cost-Benefit Analysis) and a CEA (Cost-Effectiveness analysis). The overall aim of the socioeconomic study was to examine the socioeconomic profitability of the programmes. We found a halving of expenditure for the KrAmi and Knuff groups and a 25 percent reduction for the two probation programmes compared to the cost one year before rehabilitation started.</p><p>The 15-year investment analysis (CBA) showed that expenditures decreased and benefits increased by about 2.5 million SEK per individual for the two KrAmi programmes and one non-custodial program, by 0.5-1.0 million SEK for the Knuff program and the other non-custodial program. For the KrAmi programs investment in rehabilitation pays off in 1-1.5 years, for probation in 2.5-4 years and for Knuff in 4 years after the intervention. The benefit-cost ratios were 17.8 - 12.7 for the two KrAmi programs and 5.1 - 5.8 for the two non-custodial programs. For the Knuff program the benefit-cost ratio was 13.2. KrAmi rates are higher for rehabilitation rate (pension points), rehabilitation rate compared to investment costs and benefit-cost ratio, pay-off time is the shortest.</p><p>The results of both the effect study and socio-economic study, which were presented in the first article, suggest that social improvements for the clients corresponded with socio-economic profitability. However, these findings should be interpreted with caution due to difficulties in comparing short-term data on effects from ASI interviews collected in one period with long-term data concerning socio-economic costs per day per client in a different period. The second article elaborated on these design issues and also examined whether approaching an evaluation from different perspectives and employing different research methods can increase understanding. The conclusion drawn was that it was essential to have knowledge on the dissimilarities in design and measures between the two studies to come to the correct interpretations. These interpretations led to new questions to illuminate the results of the evaluations.</p><p>In the third article the focus was the long-term follow up period. In this study the Knuff program was excluded from the study and the two KrAmi programs formed the program group and the two probation group formed the control group. The follow-up period was two years during which the socioeconomic costs decreased stepwise for both groups, probation groups more so than program groups. The deteriorations were 70-80% compared to the period before treatment. However rehabilitation to labour market was more successful for program groups than for control groups thanks to the greater socio-economic profitability for program groups.</p><p>The introductory part of this dissertation focuses on methodological difficulties, and a multivariate regression analysis (MRA) is presented which shows that pre-existing differences in the composition of the program groups and control groups were not responsible for the differences on the socio-economic results. Moreover the introductory section includes a research presentation and the rationale for socioeconomic evaluation.</p>

The general purpose of this dissertation is to evaluate KrAmi – a correctional program for young offenders – regarding socioeconomic profitability. Evaluating socioeconomic results enables us to examine and reflect upon the possibilities of applying socioeconomic models to social work. The basic data, from a long-term follow up study of 140 persons in two KrAmi programs, one Knuff program and two probation programs (treatment as usual), also allow systematic comparisons with more traditional evaluation models The data have been presented in one research report and three articles. The research report examines both the effects in an effect study and the socioeconomic results in a CBA (Cost-Benefit Analysis) and a CEA (Cost-Effectiveness analysis). The overall aim of the socioeconomic study was to examine the socioeconomic profitability of the programmes. We found a halving of expenditure for the KrAmi and Knuff groups and a 25 percent reduction for the two probation programmes compared to the cost one year before rehabilitation started. The 15-year investment analysis (CBA) showed that expenditures decreased and benefits increased by about 2.5 million SEK per individual for the two KrAmi programmes and one non-custodial program, by 0.5-1.0 million SEK for the Knuff program and the other non-custodial program. For the KrAmi programs investment in rehabilitation pays off in 1-1.5 years, for probation in 2.5-4 years and for Knuff in 4 years after the intervention. The benefit-cost ratios were 17.8 - 12.7 for the two KrAmi programs and 5.1 - 5.8 for the two non-custodial programs. For the Knuff program the benefit-cost ratio was 13.2. KrAmi rates are higher for rehabilitation rate (pension points), rehabilitation rate compared to investment costs and benefit-cost ratio, pay-off time is the shortest. The results of both the effect study and socio-economic study, which were presented in the first article, suggest that social improvements for the clients corresponded with socio-economic profitability. However, these findings should be interpreted with caution due to difficulties in comparing short-term data on effects from ASI interviews collected in one period with long-term data concerning socio-economic costs per day per client in a different period. The second article elaborated on these design issues and also examined whether approaching an evaluation from different perspectives and employing different research methods can increase understanding. The conclusion drawn was that it was essential to have knowledge on the dissimilarities in design and measures between the two studies to come to the correct interpretations. These interpretations led to new questions to illuminate the results of the evaluations. In the third article the focus was the long-term follow up period. In this study the Knuff program was excluded from the study and the two KrAmi programs formed the program group and the two probation group formed the control group. The follow-up period was two years during which the socioeconomic costs decreased stepwise for both groups, probation groups more so than program groups. The deteriorations were 70-80% compared to the period before treatment. However rehabilitation to labour market was more successful for program groups than for control groups thanks to the greater socio-economic profitability for program groups. The introductory part of this dissertation focuses on methodological difficulties, and a multivariate regression analysis (MRA) is presented which shows that pre-existing differences in the composition of the program groups and control groups were not responsible for the differences on the socio-economic results. Moreover the introductory section includes a research presentation and the rationale for socioeconomic evaluation.

p. 1 - 116 / Submitted by Santiago Fabio (fabio.ssantiago@hotmail.com) on 2013-01-31T17:53:52Z No. of bitstreams: 1 111.pdf: 2050394 bytes, checksum: f54170feb1176c5a816e098f6e69f971 (MD5) / Approved for entry into archive by Fatima Cleômenis Botelho Maria (botelho@ufba.br) on 2013-02-04T14:18:39Z (GMT) No. of bitstreams: 1 111.pdf: 2050394 bytes, checksum: f54170feb1176c5a816e098f6e69f971 (MD5) / Made available in DSpace on 2013-02-04T14:18:39Z (GMT). No. of bitstreams: 1 111.pdf: 2050394 bytes, checksum: f54170feb1176c5a816e098f6e69f971 (MD5) Previous issue date: 2007 / A universalidade, integralidade e a eqüidade da atenção à saúde são os norteadores principais do Sistema Único de Saúde (SUS). Esses princípios fundamentais estão expressos na Constituição de 1988 e regulamentados na Lei Orgânica da Saúde (Lei nº 8.080/1990). Este estudo objetiva avaliar a eqüidade no acesso ao tratamento gratuito da hepatite crônica pelo vírus C e a relevância dos fatores socioeconômicos, no que diz respeito a este acesso. Para este fim investiga-se quais os fatores socioeconômicos que interferiram no acesso ao tratamento gratuito através da avaliação dos dados socioeconômicos e de tratamento de 117 pacientes portadores do HCV, tratados no Estado da Bahia, em 2005, recebendo, gratuitamente, as medicações na Farmácia de Alto Custo do Hospital Manoel Victorino em Salvador- Bahia; e se esta interferência estaria provocando distorção entre a concepção teórica e a realidade do acesso ao tratamento da hepatite C com conseqüente desacordo com os princípios fundamentais do SUS, a universalidade, integralidade e eqüidade de acesso aos serviços de saúde, em todos os níveis, e da igualdade da assistência à saúde, sem preconceitos ou privilégios de qualquer espécie. Estabelece-se o perfil socioeconômico dos pacientes tratados, estima-se os custos totais para o setor público com os medicamentos e analisa-se a estrutura dos custos, por origem dos pacientes tratados e por classe de renda. Na análise da influência do grau de escolaridade no acesso constatou-se que o grupo de pacientes com o ensino médio completo ou mais corresponde a mais de 63% e os pacientes sem escolaridade a, apenas 0,85%. Na avaliação do rendimento familiar mensal, a classe de renda que apresentou o maior número de pacientes foi a de mais de 5 a 10 salários mínimos com 26,50%, seguida da classe de mais de 3 a 5 salários mínimos com 22,22% dos pacientes tratados. Na cobertura de saúde, ocorreu a predominância daqueles pacientes cobertos por planos de saúde com 60% por cento em relação aos que não possuíam plano com 40%. Na análise dos gastos públicos com o tratamento da hepatite C, os pacientes com rendimento de mais de 5 a 10 salários mínimos foram os que tiveram os maiores gastos, correspondendo a 23,45%, seguidos dos pacientes com renda de mais de 3 a 5 salários mínimos, com 23,00%, longe dos 8,95% gastos com os pacientes que ganham até 1 salário mínimo e dos 15,98% gastos com os pacientes que ganham mais de 1 a 2 salários mínimos. A conclusão do estudo mostra que os fatores socioeconômicos interferiram e determinaram iniqüidade no acesso dos pacientes ao tratamento gratuito da hepatite crônica pelo vírus C, o que se refletiu na distribuição dos gastos públicos relativos a este tratamento. / Salvador