MKBA, social cost benefit analyses for better care and well being

The ‘Betuwelijn’, the High-Speed Line, the construction of the ‘Tweede Maasvlakte’, these are but a few examples of large Dutch infrastructure projects which have been decided after a social cost-benefit analysis (SCBA). An SCBA is a comprehensive ex ante assessment of the costs and benefits of a policy decision from a societal perspective. It provides an overview of the welfare effects of policy, which are expressed in monetary terms. The general principles for the drafting of an SCBA and the requirements that an SCBA has to meet, are laid down in the general guidelines for social cost-benefit analysis of the Netherlands Bureau for Economic Policy Analysis (CPB) and the Netherlands Environmental Assessment Agency (PBL). The SCBA is no longer limited to the infrastructure industry. The Dutch government wants the SCBA instrument to be used in all policy fields, where it is considered useful for decision making. In the fields of health and welfare, its use is still relatively exceptional. Before SBCAs can be used on a wider scale, some methodological issues have to be worked out. Tuning with the more usual cost-effectiveness analyses (CEAs) is an important precondition. In addition, the distribution effects must be on the agenda. Particularly in the field of health care and well-being, these effects are very important, but still largely ignored in an SCBA. The National Institute for Public Health and the Environment (RIVM) has a tradition of CEAs, but takes first steps in the field of SCBAs, especially when it comes to cost and benefits of measures that go beyond health and health care. The RIVM has, for example, plans to use the guidelines for a number of practical applications. This will be done in cooperation with the Department of Health Services Research at Maastricht University as well as others. The same department also investigates the costs and benefits of interventions within sectors that go beyond health and health care, such as the deployment of police and justice.

By providing some examples of SCBAs, this edition of Spectrum shows what can be the proceeds of an SCBA. The Buddy Network is a professional organization of volunteers (buddies) who support different target groups. The SCBA showed that the benefits outweighed the costs. This also applies to the ’Helping Hands’. Helping Hands, a neighborhood training company located in the district Sterrenburg in Dordrecht, puts trainees to helping vulnerable older residents. The process of making an SCBS turned out to be at least as valuable as the positive results of the cost-benefit balance. The process provided clues to go with (new) parties in talks on cooperation and co-financing. In the field of youth, the need for SCBAs is large. This is understandable given the major changes faced by this sector.

Looking ahead, the SCBA is a promising tool to help achieving better care and welfare. This issue of Spectrum shows that there is perspective for a larger use of SCBAs.