Download Estimation of drug trade

The classification of drug-related expenditures:
COFOG and the Reuter’s programme division
Jiri Vopravil (Czech Statistical Office, University of Economics in Prague)
Luis Prieto (EMCDDA)
Viktor Mravcik (Czech National Focal Point for Drugs and Drug Addiction)
Introduction
In response to the EU Drugs Action Plan (2005-2008), the EMCDDA has recently initiated
the standardization of a methodology for the quantification of the public expenditure in the
field. Reitox Academy made for the drug-related public expenditure one-day workshop in
Luxembourg (spring 2007). The compilation of countries expenditures in the field was
published by the EMCDDA in Selected Issue 2008: Towards a better understanding of drugrelated public expenditure in Europe. Several tasks in the area were discussed on NFP (core
group) meeting on the standard tables on public expenditure in EMCDDA (Lisbon September
2008).
To allow for systematic comparability of drug-related funds across countries, a categorization
scheme based in the International Classification of the Functions of Government (COFOG)
has been proposed. Detailed 3-levels structure of COFOG includes financial flows of the
public finance, which are going from state and local (regional and municipal) budgets to nonprofit organisations (NPOs) with drug-policy programmes.
The extensive structure of COFOG contrasts with the four-category division introduced by
Reuter (2006) on the basis of the likely effects of services provided by drug policy
programmes (i.e. prevention, treatment, enforcement and harm reduction). The Reuter’s
programme division is classification of the recipients (NPOs) with drug-policy programmes.
As part of the national reporting exercise for 2007, drug-related expenditure per country was
identified by the EMCDDA’s network of 30 national focal points (NFPs). The NFPs were
asked to list any budgeted drug-related funds in previous years. In order to ensure
consistency in comparing expenditure over time and across countries, labelled expenditure
was classified by means of COFOG and Reuter’s programme division. By reviewing the
COFOG and Reuter’s classification of expenditures in Ireland, France, Luxembourg,
Hungary, Portugal, Slovakia, Finland, and the United Kingdom, the study presents the
comparative linkage of the two classification schemes. In the last year, the Czech National
Focal Point made also some experiences with links between the two classifications.
Public expenditures on drug policy are divided labelled and non-labelled. Labelled
expenditures on drug policy are budget items, which the individual budgetary organisations
of state administration keep in their budget. Non-labelled are the expenditures, which are not
directly intended for the addressing of drug-related issues, but they are still involved in
addressing drug-related issues. In this paper attend to the labelled expenditures only.
COFOG classification
COFOG (Classification of the Functions of Government) is a functional classification used by
SNA 1993 (System of National Accounts 1993). COFOG is useful international classification
for spatial comparison (between countries) and for time comparison (over time) also.
National statistical institutes from each EU member state shall transmit to the Commission
(Eurostat) the expenditures of general government by function (in the classification COFOG)
under Regulation (EC) No 1392/2007 of the European Parliament and of the Council of 13
November 2007 amending Council Regulation (EC) No 2223/96 with respect to the
transmission of national accounts data.
COFOG is in practice very similar. In principle, its units of classification are individual
transactions. This means that each outlay (purchase or transfer) should be assigned a
COFOG code according to the function that the transaction serves. This principle is valid for
both transfers capital (investment) and current (non-investment) transfers.
The classification has three levels of detail which are referred to as follow:
- 01.
- 01.1
- 01.1.1
Division (or two-digit level);
Group (or three-digit level);
Class (or four-digit level).
Administrative expenditures should be classified at the most detailed level possible – that is
the class. Then the aggregating amount should be presented at COFOG groups or divisions.
For certain functions, COFOG has drawn on classifications that have been made specifically
for these functions. For example, grants to hospitals are classified under Hospital services.
Reuter classification
Second useful classification of founding drug policy for policy makers is Reuter’s drug
programme division:
Prevention programmes: reduce initiation or the probability of progress from experimental to
regular drug use, either by persuasion or by reducing the accessibility of drugs for novice
users.
Treatment programmes: reduce drug use by experienced users through direct individual
service (e.g. medical and counselling services).
Enforcement programmes: programmes aimed at traffickers and producers to shift up the
supply curve for drugs; other things being equal, they should raise the price of drugs and
lower quantity. Programmes aimed at users and retailers raise the transaction costs of
buying drugs; those efforts shift the demand curve downwards and lower price and
quantities.
Harm reduction programmes: seek explicitly to reduce the adverse consequences of drug
use. There are two categories: harm prevention aims to reduce the risk of harm conditional
on drugs; harm amelioration aims to reduce the severity of specific harms after their
occurrence (e.g. treatment of HIV positive patients, psychiatric treatment for co-morbidities).
Czech experience with drug programmes division
There are few different classification of the drug programme types in the Czech Republic
based on the different systems (health/social/education), administrative bodies
(departments/ministries), funding schemes providing subsidies to the drug services, and last
but not least the custom approach based on the natural development of drug services in the
Czech Republic before 1989 and over the last 20 years. There are a lot of overlaps and
compatibility in terms of the definition of programme types between different systems,
however some distinct types of services defined within various systems in the Czech republic
exist.
Ministry of health – mainly medical treatment and harm reduction
Ministry of health’s policy stems mainly from the Act on Measures for Protection from Harm
Caused by Tobacco Products, Alcohol, and Other Addictive Substances (No. 379/2005 Coll.)
adopted in August 2005. It came into force on January 1, 2006 and replaced the previous Act
on Protection against Alcoholism and Other Drug Addictions (No. 37/1989 Coll.), which was
inherited from communist era and was not compatible with new reality of democratic regime.
For the first time (and as late as 16 years after democratic changes and 16 years of partly
natural and partly coordinated development of drug services), the law defined the types of
drug services for drug users as:
1.
2.
3.
4.
acute medical in-patient treatment;
detoxification;
outreach programmes;
contact and counselling service (i.e. low-threshold harm reduction office-based
programmes);
5. out-patient treatment;
6. stationary day-care programmes;
7. short-term and mid-term in patient medical treatment (5-14 weeks);
8. therapeutic communities in medical and non-medical setting (6-15 months);
9. aftercare programmes;
10. opioid substitution treatment.
Aside from above mentioned classification, the funding scheme of Ministry of health
distinguishes so-called “AT out-patient clinics” (AT – alcohol/toxicomania) as the special
category of traditional type of specialised out-patient medical treatment facility. Basically, AT
clinics are the out-patient medical psychiatric offices specialised in substance abuse
treatment. They were introduced in the deep history of communist era and still have the
semi/official status seen for example in the contracts between the medical facilities and
health insurance companies.
Moreover, one additional traditional medical facility dealing with substance (mainly alcohol)
users can be distinguished in the Czech Republic – so-called “sobering-up stations”, which
are facilities for short term (in hours) “medical detention” and detoxification of persons with
acute psychotropic substance’s intoxication causing public nuisance. Operation of “soberingup stations” is (after administrative reform in 2001) under competence of the regional
administrations.
Ministry of social affairs – social service for drug users
The Act 108/2006 Coll. on social services was adopted in 2006. The previous legislation in
the field of social services was completely inadequate – as far as social services are
concerned, it only used to involve institutional care and community care service; no legal
regulations were available for other types of services.
The present act defines 31 types of social services, divided into: (1) social care services; (2)
social prevention services, and (3) social counselling, which is the basic activity during the
provision of all types of social services. The act mentions drug users as the target group of
several types of social services. In 2007, drug users were target group of following “standard”
types of social services:
1. outreach programmes;
2. contact centres;
3. low-threshold day care centres;
4. social counselling;
5. crisis care;
6. social services in medical treatment facilities;
7. social rehabilitation;
8. therapeutic communities;
9. aftercare;
10. residential facilities with special regimen (includes almost exclusively residential
facilities for elderly alcoholics, which are not considered as typical drug services).
Ministry of education – from universal prevention to early intervention
The process of the professional competency (certification) of prevention programmes was
launched in 2006 and has become a part of the system of Certification of the professional
competency of drug services coordinated by the interdepartmental Government council for
drug policy coordination (see below), however as the part managed separately by the
Ministry of education. Following types of prevention programmes are defined:
1. programmes of specific primary prevention supplied within the framework of school
curricula;
2. programmes of specific prevention supplied extracurricularly;
3. early intervention programmes;
Then two other types of programmes in the field of education/training of professionals
and publication activities are defined:
4. educational programmes in the field of specific primary prevention;
5. editorial activity in the field of primary prevention.
Certification of the professional competency of drug services
In the Czech Republic, a system for the certification of the professional competency of
services for drug users started to operate in the Czech Republic in 2005 as the
interdepartmental and interdisciplinary project of the Government council for drug policy
coordination, which is central coordination body for drug policy in the Czech Republic. Thus,
as such, it has been accepted by all ministries, although the ministry of social affairs, sue to
its own strong regulation defined by the Law on social services accept the system less
officially and strongly and has to follow primarily the classification given in the legislation of
social services.
The system of the certification is based on the implementation of Quality Standards (QSs).
Certification is not obligatory, but only certified programmes run by NGOs should be
subsidised from the state budget after 2007 (decree of the government). It distinguished
between following standard type of services:
1. outreach programmes;
2. contact and counselling services (i.e. low-threshold harm reduction office-based
programmes);
3. detoxification;
4. substitution treatment;
5. outpatient treatment;
6. day-care programmes;
7. short-term and medium-term institutional treatment;
8. inpatient treatment in therapeutic communities;
9. outpatient aftercare programmes;
10. preventive programmes.
Compilation of all programmes classifications used in the Czech
Republic into one classification
The services identified in the different Czech systems where included into the one based on
the Reuter’s classification with extension (Aftercare) or disaggregation (Harm reduction and
Treatment) of some of the conventional categories (see Table 1).
Table 1: Consolidation of the different definitions of demand reduction program types into one
classification
Service
Sector
Category/type of programme
category
Prevention
Educational
- programmes of specific primary prevention supplied within the
framework of school curricula
- programmes of specific prevention supplied extracurricularly
- early intervention programmes
Others
- prevention programmes
Harm reduction Health
- outreach programmes
- contact and counselling service
Social
- outreach programmes
- contact centres
- low threshold day care centres
Interdepart.
- outreach programmes;
- contact and counselling services
Treatment
Health
- acute medical in-patient treatment
- detoxification
- out-patient treatment
- stationary day-care programmes
- short-term and mid-term in patient medical treatment
- therapeutic communities
- opioid substitution treatment
- AT clinics
- sobering-up stations
Social
- social counselling
- crisis care
- social services in medical treatment facilities
- social rehabilitation
- therapeutic communities
Interdepart.
- detoxification,
- substitution treatment
- outpatient treatment
- day-care programmes
- short-term and medium-term institutional treatment
- inpatient treatment in therapeutic communities
Aftercare
Health
- aftercare programmes
Social
- aftercare programmes
Interdepart.
- outpatient aftercare programmes
Moreover, we have amended the existing classification with some new items covering other
functions, which became standard parts of present drug policies and which are identifiable in
the public budgets as a distinguished and standalone activities, e.g. Coordination and
Research (see Table 2).
Table 2: Labelled drug policy expenditures by type of services in the Czech Republic 2007 (€
thousand)
Total
State
Local
Service category
budget budget
abs.
%
Prevention
Harm
reduction
Treatment
Low-threshold centres
Outreach programmes
Unspecified1
Total
Medical care2
Non-medical care3
Therapeutic communities
Unspecified
Total
Aftercare
Law enforcement
Coordination, research, evaluation, education, information 4
Others, unspecified5
Total
852
1,858
944
262
3,063
520
464
1,550
0
2,534
423
5,792
297
257
13,217
901
1,019
620
376
2,015
412
2,039
432
79
2,962
317
0
308
363
6,867
1,753
2,876
1,564
638
5,078
932
2,503
1,982
79
5,496
739
5,792
605
620
20,084
8,7
14,3
7,8
3,2
25,3
4,6
12,5
9,9
0,4
27,4
3,7
28,8
3,0
3,1
100,0
Data source: Czech national Focal Point (Mravcik, 2008)
Link between the two classifications
After detailed exploration of COFOG classification, we found that the labelled public
expenditures on drug policy might be recorded in the items of COFOG as follows:
Table 3: Drug policy expenditures by functions (COFOG) in the Czech Republic
COFOG divisions
COFOG groups
01.1 Executive and legislative organs, financial and fiscal affairs,
01 General public services
external affairs
03.1 Police services
03 Public order and safety
03.4 Prisons
07.1 Medial products, appliances and equipment
07.2 Outpatient services
07 Health
07.3 Hospital services
07.4 Public health services
07.6 Health n.e.c.
09 Education
09.5 Education not definable by level
10 Social Protection
10.7 Social exclusion n.e.c.
When we have the description of the drug policy public expenditures in the two classifications
(COFOG and Reuter’s), we could try to elaborate a matrix with two classifications (see Table
4). The matrix could be a tool for correct recording of individual transfers, when we already
record into one classification but we are not sure when to record into second classification.
1
The item includes activities of both low-threshold facilities and outreach work (street work).
The item includes: AT services, substitution treatment, detoxification, day-care centres, medical impatient care,
and sobering-up stations.
3
The item includes: outpatient and intensive outpatient non-medical programmes, crisis intervention, social
counselling, social rehabilitation.
4
The item includes: drug demand reduction-related expenditures mainly which do not involve direct provision of
services to clients.
5
The item includes: expenditures, which have not been identified in terms of their purpose.
2
Table 4: Matrix of drug policy expenditures in the Czech Republic 2007 by the two
classifications
COFOG classification
Reuter’s adjusted classification
01.1 03.1 03.4 07.1 07.2 07.3 07.4 07.6 09.5 10.7
Prevention
x
x
Low-threshold centres
x
x
x
Harm
reduction Outreach programmes
x
x
x
Medical care
x
x
x
x
Treatment Non-medical care
x
x
Communities
x
Aftercare
x
Law enforcement
x
x
Coordination, research, information
x
x
x
x
Conclusions and discussion
The recording of each transfer of labelled drug policy expenditures into classification COFOG
seems very difficult. The Czech Republic is a small country, but there are hundreds of
transfers. Several transfers are impossible record as one item of COFOG, because services
overlap (e.g. syringes exchange).
The labelled drug policy expenditures could be indicates as one total budget item for drug
policy. Division of the labelled drug policy based on Reuter’s classification is useful for policy
makers.
Non-labelled drug policy expenditures would be record into both classifications (Reuter’s and
COFOG), because their estimations are based on attributable fractions in individual services.
Since the services for drug users are similar between countries, it would be useful to extend
the Reuter’s classification and to add several items of drug policy services (described above)
into the classification. The classification would be more useful for drug policy makers.
References
European Monitoring Centre for Drugs and Drug Addiction (2008). EMCDDA 2008 Selected
issue – Towards a better understanding of drug-related public expenditure in Europe.
Luxembourg: Office for official Publications of the European Communities.
Mravčík, V., Chomynová, P., Orlíková, B., Pešek, R., Škařupová, K., Škrdlantová, E.,
Miovská, L., Gajdošíková, H., Vopravil, J. (2008). Annual Report: The Czech Republic –
2007 Drug Situation. Praha: Úřad vlády České republiky.
Regulation (EC) No 1392/2007 of the European Parliament and of the Council of 13
November 2007 amending Council Regulation (EC) No 2223/96 with respect to the
transmission of national accounts data.
Reuter, P. (2006). What drug policies cost. Estimating government drug policy expenditures.
Addiction, 101, pp. 315-322.
Key words: public expenditures on drug policy, Reuter’s classification, COFOG, labelled
and non-labelled drug-related expenditures.