Socioeconomic evaluation of postal and telecommunication services for disabled persons : applications to text telephone and videophone relay services

Abstract: Introduction: The Swedish National Post and Telecom Agency provides services in the postal and telecommunication field aimed at several groups of disabled persons in Sweden. The services included in this study were the text telephone relay service and the videophone relay service. The services make distance communication possible for deaf and hearing-impaired persons. Text is transformed to speech and vice versa via the text telephone relay service, which has 8 000 users (year 2000). Via the videophone relay service, sign language is transformed into spoken language and vice versa. The videophone relay service has 300 users (year 2000). Approximately 8 000-10 000 persons are deaf since childhood in Sweden. It is estimated that approximately 5 000 persons have become deaf in adult age and about 400 000 are hearing-impaired and users of adequate assistive services. This implies a need for communication services aimed at this target group. Scarce resources in society necessitate that evaluations must be carried out to investigate the cost-effectiveness of interventions. There was a need for a model that facilitates socioeconomic evaluations of postal and telecommunication services for disabled persons.Aim: The aim of this thesis was to develop a socioeconomic model for assessing postal and telecommunication services for people with disabilities, and to apply the socioeconomic model to users of text telephone and videophone relay services.Methods: The model development included the WHO Classifications ICIDH-2 and ICF, a literature review, reference panel opinions, expert opinions and pilot studies. The socioeconomic model was applied to people born deaf using texi telephone and videophone relay services in a longitudinal study. The number of respondents was 41 out of 63 persons. Data collection was made through posted questionnaires.Results: The model encompasses background variables, quality of the service(s), costs and outcomes. The quality of the service refers to the quality in structure and process. Costs for different actors are included, e.g. the user, family members, county councils, local authorities and the government. Outcomes of the service are divided into intermediate outcomes (direct communicative outcomes) and generic outcomes (quality of life). The socioeconomic model is general and applicable with different rehabilitation interventions. The application showed that the ratings of the quality of the services and the intermediate outcomes were significantly higher for the videophone relay service than for the text telephone relay service (p<0.05). The incremental cost was approximately SEK 40 000 (EUR 4 510) higher per person and year for the group with access to both the text telephone relay service and the videophone relay service than for the group with access to the text telephone relay service only (year 2000). In the financial analysis, the distribution of costs showed that the user, the Swedish National Post and Telecom Agency and The National Swedish Board of Health bear a considerable part of the costs. Family members and county councils bear a smaller amount of the costs. There were no differences in ratings of quality of life between the groups of text telephone relay service users and videophone relay service users. The target group expressed high ratings of quality of life.Conclusions: The model is applicable to various postal and telecommunication services in varying environments. The incremental cost for the videophone relay service compared to the text telephone relay service was almost SEK 40 000 higher. The quality of the service and intermediate outcomes showed higher ratings for the videophone relay service. Quality of life and problem-solving ability showed no difference between users of text telephone and videophone relay services.