An Exploration of the Costs of Services Funded by Vocational Rehabilitation

In eras when fiscal resources become constrained, policymakers and politicians often place increasing emphasis on evaluating human service programs by the costs they generate (Boardman, Greenberg, Vining, & Weimer, 2006). This is typically done through "cost-effectiveness analyses. " Such methodologies compare the pecuniary expenditures associated with arriving at a pre-specified outcome (Conley, 1973, Levin & McEwan, 2000). For example, Grant, Mohtadi, Maitland, and Zernicke (2005) investigated whether home-based rehabilitation programs were more cost-effective at achieving successful outcomes than traditional, program-based, physical therapy. They determined that home-based programs achieved similar results as traditional therapy, but for lower costs. Similar research has been routinely conducted to evaluate programs funded by Vocational Rehabilitation (VR). For instance, numerous studies have explored the costs incurred by VR as a result of funding supported employment (cf. Hill et al., 1987; McCaughrin, Ellis, Rusch, & Heal, 1993; Noble, Conley, Banjerjee, & Goodman, 1991; Wehman et al., 1985). Other studies have explored the costs of returning injured workers back to work (Wall, Ogloff, & Morrissey, 2006) or providing vocational services to specific populations, such as individuals with substance abuse issues (Shepard & Reif, 2004). Although, monetary expenditures are not the absolute bottom line when evaluating the worth of any program, cost-analysis is one way of evaluating outcomes and programmatic efficiency. In order to enhance programs and to enable them to serve more people, policymakers and practitioners would do well to understand what programs cost, what variables influence these costs, and whether costs are increasing or decreasing over time. Without understanding such concepts, advocates of programs may find it difficult to justify the funding that they receive, let alone be able to improve the efficiency of the services that they provide. However, as important as cost-accounting research can be, it has at least two fundamental weaknesses. The first is that the costs generated in one locale may not be indicative of costs generated in another (Lewis, Johnson, Bruininks, Kallsen, & Guillery, 1992). That is, cost studies conducted in one city or state are unlikely to shed much light on the costs generated by similar programs in other locations. Thus, the utility of localized cost-effectiveness studies are often called into question (Layard & Glaister, 1994). Second, programmatic costs are highly fluid. Minor changes in policy, funding mechanisms, or personnel preparation could produce significant changes in the costs generated by programs (Conley, 1973). Consequently, cost data quickly becomes out-of-date. In other words, results from cost studies, regardless of how well they were conducted, will have little resemblance to outcomes achieved more than a few years after their publication. For this reason, cost-effectiveness studies have to be frequently reconducted in order for an accurate picture of a program's contemporary costs to be obtained. The present study sought to investigate three critical questions related to the costs of services funded by VR. The first simply involved determining the average cost of services that VR provides to its consumers. Such analyses have been conducted in the distant past (cf., Bellante, 1972; Conley, 1969; Dean & Dolan, 1991; Worrall, 1978). However, data from these studies are extremely dated and are no longer applicable to contemporary policy. The second analysis examined the cost-trends of VR's services. That is, the present study posed the question: "Are the costs of VR's service increasing over time? " This is a vital issue given that some recent analyses have found that cost of services provided to supported employees through VR have increase dramatically since the 1990s (Cimera, 2006; Rusch & Braddock, 2005). …