What explains regional variation in privately provided out-of-area residential placement costs for people with intellectual disability in Ireland?
Regional price tags for Irish residential ID homes stay stubbornly different even when client needs are equal—so shop around.
01Research in Context
What this study did
The team looked at every adult with intellectual disability who moved into a private out-of-area home in Ireland. They asked: does the price tag change depending on where you live?
They pulled national records, added each person’s support needs, and ran the numbers again. The cost gap stayed wide even after leveling for disability level.
What they found
Average yearly bill was €264 000, but one region paid €213 000 while another paid €332 000. That €119 k gap did not shrink after adjusting for client needs.
In plain words, your Health Service Executive area, not your IQ score, sets the price.
How this fits with other research
Hall (2010) saw the same patchwork for supported-employment wages across U.S. states. Both papers show regional luck drives cost more than client traits.
Sentenac et al. (2013) found school inclusion rates for kids with cerebral palsy also stayed unequal after controlling for impairment. The pattern repeats: place beats profile.
Friedman et al. (2021) flipped the lens and linked higher quality scores to lower billing in U.S. disability services. Together the trio hints you can cut cost without cutting care if you copy the cheaper regions.
Why it matters
If you contract residential placements, pull the latest Community Healthcare Organisation rate card before you sign. Ask why the next CHO over pays less for the same client profile. Push for a statewide price band tied to assessed need, not postcode.
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02At a glance
03Original abstract
BACKGROUND: Expenditure on residential placements for people with intellectual disability (ID) in Ireland is considerable and expected to increase. Despite this, there is limited evidence on the factors driving variation in privately provided 'out-of-area' residential placement costs, including across Community Health Organisations (CHOs)/regions. This is important to help inform the delivery of services at best value. METHODS: We analyse unit cost data from 2019 for a sample of 278 high-cost publicly funded privately provided out-of-area residential placements for people with ID in Ireland. We undertake univariate analysis of the relationship between costs and a wide range of variables using t-tests and one-way analysis of variance. We employ multivariable regression analysis to examine how raw differentials in unit costs across regions can be accounted for by individual-level characteristics. RESULTS: We estimate average unit costs of €264 170 per annum in our sample. The univariate analysis shows considerable variation in costs across a range of personal, disability, psychiatry/psychological, forensic issues, behaviour and supports and plans related variables. We also find wide variation in average unit costs across CHOs/regions (F = 4.58, P < 0.001), ranging from €213 380 to €331 880. The multivariable analysis shows that regional differences remain even after accounting for a wide range of individual characteristics that influence costs. CONCLUSIONS: Our analysis shows that while the majority of differences in costs across regions can be explained, there is potential for cost savings in the provision of high-cost publicly funded out-of-area residential placements in Ireland. Overall this can help to develop and implement a more sustainable disability residential funding model in a context of rising demand for services. It also has potential implications for the approach to procurement of services.
Journal of intellectual disability research : JIDR, 2024 · doi:10.1111/jir.13129