Using cost-effectiveness to justify a future-oriented public investment is gaining currency.
Growth & Justice has sponsored research into Smart Investments in Minnesota's Students and is readying a major report. The Wilder Foundation last week held a conference for non-profit executives, "Return on Investment: The Dollars and Cents of a Nonprofit Program's Worth." And yesterday Minnesota Organization on Adolescent Pregnancy, Prevention and Parenting (MOAPPP) sponsored a talk by Brookings Institution fellow Julia Isaacs, who spoke on "Cost-Effective Investments in Children."
Policy advocates in a wide range of fields are looking for ways to measure cost-effectiveness in an era when public budgets are tight and demand for accountability is growing. Having evidence of a return on investment, it's believed, will help them move their issues closer to the front of the funding line.
Isaacs, a former analyst for the Congressional Budget Office and Health and Human Services Department, says cost-effectiveness does resonate on the Hill. But viewing a specific policy through an economics lens also has limitations, especially when applied to education or children and families, where the payoffs take place over a long period and are distributed across a variety of beneficiaries.
First, there's the challenge of actually testing a program in a way that reliably measures its outcomes. This costs money upfront for a study designed to filter out other effects, conducted long enough to capture results adequately and replicated in different settings.
Second, determining economic impact requires a different set of analytic skills and, significantly, more money.
Third, positive influences on quality of life, health and other "normative" public goods may not be captured in measurements of cost-avoidance or economic growth.
And finally, there's the political hurdle. Evidence of cost-effectiveness may not play well if it goes against conventional wisdom or threatens entrenched interests. Paybacks may be long-term — beyond the tenure of the average elected official or the attention span of a taxpayer — and may not return directly to the funder. (For example, a cut to WIC supplemental nutrition program would show up as a savings to the federal budget, but the resulting increased costs would fall mainly on state and local governments.) And if a government entity doesn't have the revenue to invest in a cost-effective program in the first place...
During discussion after Isaacs' presentation, former Hennepin County Administrator Sandy Vargas, now president and CEO of the Minneapolis Foundation, described an instance in which county commissioners reluctantly had to shelve a home nurse program they knew would save money over the long term, because they couldn't find the new money to fund it.
Isaacs cautioned against the temptation in times of austerity to do
lite or sound-alike versions of proven interventions — cutting some steps, using less
skilled workers or otherwise diluting programs. The cost-benefit ratios
may not hold at the lower investment.
Isaacs' paper [Download pdf]
— which identified four areas of investment that merit expanded federal
funding based on their cost/benefits — addressed stages of child
development from prenatal care to the teenage years and measured
benefits that included lower health care costs, reduced crime and
incarceration, improved educational attainment and increased lifetime
earnings.
Although MOAPPP's focus is teen pregnancy and many in the audience came from health and social services, I sensed a clear understanding that public investment becomes more effective when it is viewed holistically, across disciplines and institutions. And there was an appetite for a more integrated, strategic view of how government can support positive outcomes for individuals, families and communities.
As research continues to identify more cost-effective interventions, the public is more likely to support greater investment. Policymakers will need to develop a new framework for evaluating investment options, and choices will still have to be made among competing needs and different solutions. But isn't that a good problem to have?
— Charlie Quimby
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