Schraner Ingrid, De Jonge Desleigh, Layton Natasha, Bringolf Jane, Molenda Agata
School of Economics and Finance and Social Justice Social Change Research Centre, University of Western Sydney, Australia.
Disabil Rehabil. 2008;30(12-13):916-26. doi: 10.1080/09638280701800293.
This paper identifies key methodological issues for economic analyses of costs and effectiveness of Assistive Technology (AT) systems based on the International Classification of Functioning, Disability and Health (ICF). Following the biopsychosocial model of the ICF, the paper explores the consequences for cost-effectiveness analyses of AT systems when a user centred approach is taken. In so doing, the paper questions the fiction of neutrality in economic analyses and discusses the distinction between weak and strong objectivity.
Costs are measured as all resources used when providing a particular level of environmental facilitators and reducing environmental barriers for an AT user, while effectiveness is measured in terms of the resulting increase in activities and participation of the AT user. The ICF's fourth qualifier for activities and participation, which denotes performance without assistance is used to identify the additional performance achieved due to the particular environmental factors in the current situation (first qualifier). A fifth qualifier for activities and participation is introduced to denote performance with optimal assistance, and the fourth qualifier is then again used to identify the increase in activities and participation due to the environmental factors in the situation with optimal assistance.
The effectiveness that an AT user achieves in his or her current situation can be compared with the effectiveness he or she could achieve when provided with what is considered an optimal AT system based on current technologies and user priorities. This comparison throws into sharp relief the role of AT systems as well as of universal design (UD) in reducing environmental barriers for AT users in a way that is cost-effective for society as a whole.
Cost-effectiveness analysis based on the ICF can provide powerful economic evidence for how best to allocate existing funding for AT systems. We can identify three particular scenarios in which clear recommendations can be made. In addition, cost-effectiveness analysis provides a means to identify how society can comply with its obligation towards all its members in the most cost-effective way, using a combination of AT and UD.
本文基于《国际功能、残疾和健康分类》（ICF）确定辅助技术（AT）系统成本与效益经济分析的关键方法问题。遵循ICF的生物心理社会模型，本文探讨了采用以用户为中心的方法对AT系统成本效益分析的影响。在此过程中，本文质疑经济分析中中立性的虚构，并讨论弱客观性和强客观性之间的区别。
成本衡量为向AT用户提供特定水平的环境促进因素并减少环境障碍时所使用的所有资源，而效益则根据AT用户活动和参与的相应增加来衡量。ICF中活动和参与的第四个限定词表示无协助下的表现，用于确定由于当前情况中的特定环境因素（第一个限定词）而实现的额外表现。引入活动和参与的第五个限定词表示在最佳协助下的表现，然后再次使用第四个限定词来确定在最佳协助情况下由于环境因素导致的活动和参与的增加。
可以将AT用户在其当前情况下实现的效益与他或她在基于当前技术和用户优先级提供被认为是最佳AT系统时所能实现的效益进行比较。这种比较凸显了AT系统以及通用设计（UD）在以对整个社会具有成本效益的方式减少AT用户环境障碍方面的作用。
基于ICF的成本效益分析可以为如何以最佳方式分配现有AT系统资金提供有力的经济证据。我们可以确定三种可以提出明确建议的特定情况。此外，成本效益分析提供了一种手段，以确定社会如何以最具成本效益的方式履行其对所有成员的义务，采用AT和UD相结合的方式。
