Webb Edward J D, Meads David, Gardiner Clare
Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds, LS2 9NL, UK.
Health Sciences School, The University of Sheffield, Barber House Annexe, 387 Glossop Road, Sheffield, S10 2HQ, UK.
BMC Health Serv Res. 2021 May 4;21(1):421. doi: 10.1186/s12913-021-06390-8.
Terminal illness can cause a financial burden for many households. In England and Wales, fast-track access to welfare payments is available through special rules for the terminally ill (SRTI). Individuals are eligible for SRTI if they are judged to have 6 months or less to live. This criterion has been criticised as lacking a clinical basis, and being unfair for people with conditions where life-expectancy is difficult to accurately assess.
To conduct a budget impact analysis on the possible increase in expenditure of personal independence payments (PIP) following a change in England and Wales to SRTI so that everyone with a terminal illness is eligible.
The fraction of individuals with a given long-term condition was estimated by combining data from the Health Survey for England, the Office for National Statistics (ONS) and the Department for Work and Pensions. Logistic growth modelling and ONS population projections were used to project PIP expenditure from 2020 to 2025. The increased expenditure was calculated for hypothetical scenarios which may occur following an SRTI regime change, specifically an increase of 1, 2 and 3 percentage points in the fraction of individuals claiming PIP under SRTI. Data from the literature on the projected prevalence of mild, moderate and severe dementia was used to calculate the cost if everyone with a given severity of dementia claimed PIP under SRTI.
Under the current SRTI regime, PIP expenditure under SRTI was projected to increase from £0.231bn in 2020 to £0.260bn in 2025, compared to equivalent figures of £11.1bn and £12.7bn under non-SRTI. Expenditure in 2025 following an increase in the fraction claiming of 1, 2 and 3 percentage points was projected to be £1.1bn, £1.9bn and £2.7bn respectively. In 2025, PIP expenditure was estimated to be £7.4bn if everyone with dementia claimed under SRTI, compared to £6.4bn if only individuals with moderate and severe dementia claimed, and £4.7bn if only individuals with severe dementia claimed.
Changes in SRTI are projected to lead to increases in PIP expenditure. However, the increased cost is small compared to expenditure under non-SRTI, especially as the highest costs were associated with extreme scenarios.
晚期疾病会给许多家庭带来经济负担。在英格兰和威尔士，通过针对晚期患者的特殊规定（SRTI）可实现快速获得福利金。如果个人被判定存活时间为6个月或更短，则有资格享受SRTI。这一标准受到批评，因为缺乏临床依据，且对预期寿命难以准确评估的患者不公平。
对英格兰和威尔士将SRTI变更为让所有晚期疾病患者都有资格享受之后个人独立支付（PIP）支出可能的增加进行预算影响分析。
通过合并来自英格兰健康调查、国家统计局（ONS）和工作与养老金部的数据，估算患有特定长期疾病的个体比例。使用逻辑增长模型和ONS人口预测来预测2020年至2025年的PIP支出。针对SRTI制度变更后可能出现的假设情景计算增加的支出，具体而言，即SRTI下申领PIP的个体比例增加1、2和3个百分点的情况。利用文献中关于轻度、中度和重度痴呆症预计患病率的数据，计算如果患有特定严重程度痴呆症的所有人都在SRTI下申领PIP的成本。
在当前的SRTI制度下，SRTI下的PIP支出预计将从2020年的2.31亿英镑增加到2025年的2.60亿英镑，而非SRTI下的相应数字为111亿英镑和127亿英镑。申领比例增加1、2和3个百分点后，2025年的支出预计分别为11亿英镑、19亿英镑和27亿英镑。2025年，如果所有痴呆症患者都在SRTI下申领，PIP支出估计为74亿英镑，若只有中度和重度痴呆症患者申领则为64亿英镑，若只有重度痴呆症患者申领则为47亿英镑。
预计SRTI的变更将导致PIP支出增加。然而，与非SRTI下的支出相比，增加的成本较小，尤其是最高成本与极端情景相关。
