Overview
Forecasts for the county of Dalarna in Sweden indicate that the number of inhabitants over 65 years of age will increase by between 15-33 per cent, and the ones above 85 years by 12-57 per cent, in the next 30 years from the year 2000. The lower per cent figure in the intervals are expected at unaltered mortality and the higher figures are expected at the mortality expected if current falling trends in mortality are extrapolated (DFR-report 2004:4).
Simultaneously, there is a current trend toward a higher degree of care of elderly people in their homes instead of at institutions. There are also discussions made in the County Council concerning fusions of health care centres and a change in the number of district medical offices and a centralisation is being carried out regarding specialized care functions. Within the special housing centres for elderly, the number of rooms has been reduced by 25 per cent between the years 2002 and 2005. All these changes affect and increase the need for more transports. The above described trends create an increased demand for publicly funded transports in the health care sector concerning elderly people. In Sweden, the health care sector has a divided responsibility picture were municipalities and county council account for separate sub-sectors. The relevant publicly funded transports include transport services for disabled, transports to and from health care, staff journeys as well as transports of equipment and provisions.
The total costs for the transport of disabled persons within the county of Dalarna in 2003 amounted to 52 million SEK and the costs of transports to and from health care for the county council totalled 75.6 million SEK, i e a total of 127.6 million SEK (approx. €13.7 million), costs that are increasing for each year.
The other transport costs are not well known, but they seem to be substantial and increasing. One example illustrating this is the fact that there currently are 1100 cars belonging to municipalities and the county council that are mostly used for staff journeys. The journeys are currently not co-ordinated to any greater extent. This could be compared to the total number of taxis in the whole county: 300.
The trend described above has created a demand for functional models, methods and routines for the decision making, planning and organising, and evaluation of the total amount of publicly funded transports within the health care sector. The costs for the transports must be minimised but they
The project is directed towards studying the potential for a more far-reaching efficiency and co-ordination of all publicly funded transports focusing on the health care sector. The aim is also to study the existing co-operation between the health care and transport sector to enable a better co-ordination and integration in the planning process of all publicly funded transport in the health care sector. The knowledge gathered and the solutions studied within the project may give great cost reductions for the health care sector.
There could be a great potential in studying how needs and demands, decisions, regulations and routines within the sector affect the transport system and the demand for publicly funded transport. Furthermore, the health care sector probably could be improved and develop in a more favourable manner if the transport perspective is considered on a strategic level when decisions are made. This also means that the quality of the care could be greatly improved if transport issues are considered, since the opportunity for the persons receiving care to be able to travel are a such an important part of the health care sector in general.
The following description is only applicable to the second sub project. The re-structuring of the health care sector and the influence on public economy and important goals in the national transport policy. The extent of the transportation carried out by the home-help service staff was surveyed by conducting a diary study where the staff noted their daily journeys during a week. Interviews were held with staff responsible for equipment and provisions and the taxi company responsible of transporting the disabled. A scenario was created where the number of senior citizens currently living in their homes was reduced to the level present in 2002. The reduction in the transport demand for home-help service was calculated tor the scenario. Cost-benefit assessments were made and compared for the current situation as well as for the scenario.
The project is carried out in Borlänge and Falu municipalities, the county council of Dalarna as well as the Public Transport Authority of Dalarna. The lessons learned could be implemented within the any of the municipalities. The solutions discussed in the county of Dalarna will be compared with solutions and activities being conducted in other regions and counties in Sweden.
Funding
Results
The results of the analyses show that the total travelled distance for the two municipalities is about 2.5 million kilometres. There are also huge variations in the transport patterns of the five home-help service areas. The size of the areas, the need for care and the geographical structure of the areas contribute to these variations. The results also show that geographical and administrative restrictions affect the length and time spent on transports, and that the needs for home-help service affect the number of visits made. The travelling is performed by car, bicycle and by foot, and the means for transportation is dependent on the distance and the availability of vehicles.
The time analyses show that the time spent on transportation varies between 11 to 17% of the total working hours. The cost analyses show that the total cost for transportation which includes the cost for vehicles, working hours spent on transportation and external costs correspond to a total of approximately €3.1 million. The comparison between the present situation and the scenario suggests that a cost reduction of approximately €0.5 – €0.6 million per year would be possible by physically relocating the home-help service. Calculations also show that a physical relocation of the care would reduce carbon dioxide emissions.
Technical Implications
The project experienced some difficulties in gathering relevant transport data which indicates that there are problems for the municipalities in getting the whole picture of the costs for elderly care, because when decisions are made concerning the physical location of elderly care the cost for transportation is not considered. Consequently there is a great need for ITS applications that could be used for gathering information about transport patterns and time spent on travelling which could be used when strategic decisions are made.
ITS applications could also be used to plan the logistics for the home-help service. In this planning process the assignments have to be matched with the time schedules for the personnel, and combined with road network and travel information. For example, it must be possible to have access to travel times based on e.g. walking, cycling or travelling by car in order to plan the work in an efficient way.
There is also a need for applications that could be linked to booking services for cars, and systems that provide information and booking services for public transports. Furthermore, navigation services and on-trip traffic information services would be helpful for the home-service personnel when they make their journeys.
Policy implications
It is of major interest to analyse how the transport in home-help service could be made more efficient and sustainable, by using ITS-applications. However such an analysis must be based on the needs for such systems and services from a user and workpractice perspective.