Cost-benefit analysis of a supported employment program: an experience in Korea. (Supported Employment Korea).

This article describes the use of a cost-benefit model as a tool that justifies a supported employment program in Korea. The article also provides insight into the Korean rehabilitation system as it has developed to this point. Awareness of various systems of rehabilitation can provide new insights to existing programs and services and assist with the development of new programs and services. Awareness of non-American systems can help develop tolerance and understanding in an increasingly global community.

In Korea, approximately 1.45 million persons fit within the legal definition of disability, as of the year 2000 this translates into approximately 3.09% of the total population. The 1999 Amendments of Disabled Persons Welfare Law (DPWL) of 1981 widened the scope of legal disability to include persons with kidney failure and psychiatric disabilities adding another 1/3 million persons as legally disabled.

There are four major pieces of disability legislation in Korea. Due to these legislative initiatives rehabilitation facilities and programs have increased tremendously.

During the years 1996 to 2000, the government budget more than doubled from 60,004,000 won to 147,630,000 won annually. One U.S. Dollar equals approximately 1,192 won, however the currency exchange rates fluctuate widely. The average inflation rate, at the time, was 2.4% while the Government Budget growth rates held steady between 9% and 14.5% during the same period. In spite of the legislative efforts to improve the quality of life of persons with disabilities many still experience institutional barriers and psychological stigma. National consensus to improve employment of persons with disabilities was lacking and the current unemployment rate was reaching 20% with a general unemployment rate of about 4%. Vocational rehabilitation strategies relied heavily upon a quota system. The agency responsible for the Disabled Persons Welfare Law (DPWL) had been focusing its strategies on assisting companies with 300 or more employees to comply with the quota requirement.

Rehabilitation Services

There are a couple of hundred welfare and rehabilitation institutes for persons with disabilities, with residential institutes as the predominant means for providing vocational rehabilitation services for persons with disabilities in Korea. The majority of institutes are related to job training, others provide services for those with physical disabilities and visual disorders with fewer institutes providing specialized services. The Korean System favors residential institutes over non-residential institutes for political and cultural reasons. The residential institutes serve over 16,000 persons annually.

Development of vocational rehabilitation systems and services in Korea is in a developing phase. The National Rehabilitation Center was established as a prototype rehabilitation facility in October of 1986. The services provided at this center include counseling, assessment, medical rehabilitation, prosthetic and orthopedic services, job training, and research. The Center was annexed in 1994 by the National Medical Rehabilitation Center to meet the growing need for specific medical rehabilitation services. Vocational rehabilitation services have been provided by several welfare centers for persons with disabilities and the Korea Employment Promotion Agency for the Disabled (KEPAD).

Societal changes and medical advances have led to lower rates of disability at birth. However, similar to the United States, the number of people with a disability due to accidents and age related disorders has increased (Szymanski, Linkowski, Leary, Diamond, & Thoreson, 1993). Existing Korean rehabilitation programs have been welfare-like in nature and there has been confusion between social work and rehabilitation concepts and practices. The rehabilitation service system in Korea has been dominated by social workers; hence a predominance of welfare like services that encourage residential treatment versus community based treatment. This situation provides little stimulation toward independence for people with disabilities (Steadward, 1997). Politically and culturally there are low expectations for persons with disabilities. Additionally, service providers often have no specific training in rehabilitation. As Vash (1995) pointed out, the predominant attitudes among general citizens reflect the underlying metaphysical assumptions about people with disabilities. Negative attitudes about people with disabilities produce a risk of increasing separation between the disabled citizen and non-disabled professionals preventing them from playing diverse social roles and avoiding stereotyping and stigmatization (Hahn, 1984; Oliver, 1996).

Furthermore a national survey of rehabilitation facilities conducted in 1996 by Kim, Jun, Park, Lee, & Jung demonstrated a rehabilitation staff-client ratio of 1 to 30 based on an 8-hour-work day, indicating a less favorable social atmosphere.

Disability policy making typically does not include consumers and has remained in the hands of government officials. Recent amendments to disability legislation have occurred, however, a gap among service providers, users, and the general public continues. Institutional and cultural values have resulted in restricted access to services and the provision of services in segregated settings. Rehabilitation efforts in Korea are increasingly focused on community-based services that promote inclusion and integration.

Supported Employment

Theories and methodologies of supported employment in the field of rehabilitation in Korea were introduced around 1992. Since then, educational materials concerning supported employment were gradually exposed to practitioners in a fragmentary way. Journal articles published in early 1993 dealt with basic concepts, principles, models, and procedures of supported employment. The initial effort to produce supported employment models for people with disabilities was attempted in 1994 by two rehabilitation centers in Seoul as a part of an adult rehabilitation program. This effort was regarded as successful and was immediately recognized by other practitioners. Several persons with severe disabilities were appropriately placed in competitive community based jobs and have since maintained their jobs. After 1994, many rehabilitation centers developed and operated supported employment programs based on the individual characteristics of each center and community. Therefore, there are some variations and differences in operating and defining supported employment programs in Korea.

While supported employment may be effective, a majority of vocational rehabilitation practitioners still have doubts that supported employment programs are justified. The programs are generally considered too costly. This misunderstanding is based on their intuitive judgment of the numerical ratio of staff to client. Of course, the supported employment model can be regarded as a more expensive approach than other approaches such as the sheltered employment model if one only considers the short-term input cost/elements rather than the long-term benefit/outputs of supported employment. In developing countries such as Korea, cost-benefit analysis can help organizations adopt and execute new policies or social programs because it provides evidence for better decisions and justification of service (Royse, 1995; Posavac and Carey, 1992). Policy and program planners can pragmatically determine the relative importance of alternatives or size of a program with rational, sound judgment, and whether to adopt a new program or not.

Elements of supported employment and cost-benefit analysis

For several decades, disability related legislation focused on the employment of persons with disabilities. For example, the Developmental Disabilities Act Amendments of 1984 in the United States defined supported employment as a government initiative (Powell, Pancsofar, Steers, Butterworth, Rainforth, & Itzkowitz, 1991; Moon et al., 1990). Mank, O'Neill and Jensen (1998) reported that supported employment systems for people with severe disabilities resulted in highly desirable outcomes more so than with other employment systems. Wehman et. al. 1987, reported on the organizational variations when implementing rehabilitation services. Through out the literature references have been made to the need to include persons with disabilities as a means of developing greater awareness of needs and concerns. Since humans must learn to be independent and democratic, disability policy should promote better and more inclusive systems (Skirtic, 1996). Programs that attempt to deal with a small segment of the population must consider the environment in which the program is carded out, because one of the ways to accelerate acceptance in society is accomplished through frequent exposure of people with disabilities in the community (Switzer, 1967).

Supported Employment as compared to more traditional vocational rehabilitation models has demonstrated higher wages, greater social integration, and an increased focus on skill development for individuals at job sites. The individual placement model, the enclave model, the mobile crew model, and the small business model are the predominant service delivery models used in Supported Employment today. Supported employment was conceptualized as an alternative to traditional vocational rehabilitation programs for persons with severe disabilities throughout the 1970s and 1980s. The following four elements and concepts are related to supported employment in the United States: 20 work hours per week; on-going support; integrated work settings and persons with severe disabilities (Moon et al., 1990; Verdugo, Genaro, & Arias, 1998). Several arguments in support of and against supported employment have been provided by comparing programs based on consumer wages, hours worked, job satisfaction and program costs for participants (Lam, 1986; Wehman et al., 1987).

For the past two decades, most cost-benefit analyses of vocational rehabilitation programs have been conducted in the United States (Baer et al., 1992; Conley & Noble, 1990; Hill & Wehman, 1989; Noble & Conley, 1987; Rusch et al., 1993; Struthers, 1977; Wehman, Kregel, Banks, Hill, & Moon, 1987). Initially, the discipline of welfare economics conceptualized the assessment of social projects, which regards a social project as desirable if the benefits exceed the estimated costs (Pearce & Nash, 1981). As evidenced in the United States Flood Control Act of 1936, cost-benefit analysis is concerned with evaluation of the efficiency of public programs and agency performance (Struthers, 1977). Cost-benefit analysis aims to improve the management and the size of a program (Hallak, 1981). It is a form of program evaluation making the best use of scarce resources by the best allocation to maximize human welfare. Concerning accountability, rehabilitation professionals who examine vocational rehabilitation alternatives would therefore determine what is the best alternative for the whole society.

However, the preferences of individuals who comprise society are also important, therefore the utility of cost-benefit analysis will rest on a value judgment (Pearce & Nash, 1981). Cost-benefit analysis seeks to quantify the resources consumed by a program, and to relate these resource expenditures to the monetary benefits or program effects obtained. Cost-benefit analysis in the field of vocational rehabilitation is relatively scarce and research results are inconsistent (Wehman et al., 1987). In a large scale research study Wehman et al. (1987) showed that estimated average annual wages for supported employment ($ 3,144) were about doubled compared to those of sheltered workshop participants ($ 1,611). This kind of analysis has not been done yet in an Asian region.

Most cost-benefit analyses of supported employment have been carried out by scrutinizing the outcomes of an existing program based on the present value criteria, while economic or policy areas have been focusing on the present value and future value criteria. Struthers (1977) suggested three models, the net present value approach, the cost/benefit ratio approach, and the internal rate of return approach, as appropriate for analyzing vocational rehabilitation programs. Where the cost-benefit analysis of supported employment utilizes the net benefit and the cost-benefit ratio approaches, the internal rate of return approach is hardly considered in use of rehabilitation programs due to the mathematics involved (Struthers, 1977). Of these analysis models, the cost-benefit ratio is considered as the most easily interpreted and commonly used method (Struthers, 1977). For this model, which utilizes Thornton's Accounting model, there are three perspectives, society, taxpayers, and employees (Conley et al., 1990; Rehabilitation International, 1981; Rusch et al., 1993; Sav, 1989; Wehman et al., 1989).

Cost-benefit analysis of supported employment often regards the transfer payment as a significant fact when conducted in the context of the taxpayer's perspective (Say, 1989). The following simple calculation formulas are in use.

1. Net average rate of return = Sum of net benefit/number of years

2. Net present value = sum of net benefit * social reduction rate

3. Cost-benefit ratio (benefit per unit) = Sum of net benefit/total costs, low benefit < 1 < high benefit

4. Net benefit (the size of benefit) = total benefit vs. total cost, valueless in policy < 1 < value in policy

5. Internal rate of return = expected rate of return for total period.

Research results of supported employment have demonstrated increased social integration yet have not proven to be positive and encouraging with regard to cost. These different research results have brought about questions as well as cautions related to interpretation of findings (Rusch et al., 1993). Several researchers have questioned the validity of cost-benefit analyses of supported employment (Baer, Simmons, Flexer, & Smith, 1992). Conley and Noble (1990) conducted an analysis of studies in Illinois, focusing on the efficiency of supported employment programs. In this study the start-up costs decrease as time goes on while the earnings of program participants grow significantly, thereby magnifying the cost-benefit ratio. This phenomenon requires longitudinal studies of supported employment. The Illinois study of 1987 revealed a cost-benefit ratio of 0.75, while the New York study revealed a cost-benefit ratio of 0.59 for the period, 1988 through 1990 (Conley & Noble, 1990). In these cases, persons with severe disabilities who participated in supported employment programs earned twice as much as in similar vocational rehabilitation programs, but the initial cost put into the supported employment programs were very high. Hill and Wehman (1989) calculated the benefit-cost ratio 1 to 1.2 and a $90,000 thousand US dollar net benefit (620-530) from the four year supported employment programs. When data for eight years are used, they obtained the benefit-cost ratio 1 to 1.5.

Noble and Conley (1987) also conducted cost-benefit analyses of several adult rehabilitation programs, such as sheltered workshops, work activities centers, adult day care centers, and supported employment programs. As a result, they found that the supported employment programs are less costly than other programs, and earnings of the supported employment programs are the highest.

Rusch et al (1993) analyzed the benefits and costs of supported employment in Illinois during a four-year period, 1987 through 1990 utilizing social, taxpayer, and employee perspectives. During this period, supported employees increased their net earning by 42%, while society received a return of $91 and taxpayers $77 for every $100 spent on the program. However, the fourth year of the project resulted in the societal return of $109 and a return to taxpayers of $89 for every $100 spent, and the net earnings for supported employees were increased by 57%. Furthermore, Say (1989) compared employment data obtained from the Project Employability (PE) for a period of 47 months, and the data from the Structure Training and Employment Transitional Services (STETS) program. In this study his analysis revealed that the social cost-benefit ratio was 1.8 and 0.83 for each PE and STETS respectively. The practical costs were not so different, however all this research was carried out using a different methodology and resulted in different types of data collected (Lavery, 1994). The relationship of the data to the Korean situation can help justify the use of this model as supported employment develops and grows as a rehabilitation program strategy. Previous use of a model in the United States can help Korean researchers understand the appropriate use and application of the cost-benefit model and avoid problems of interpretation and generalization to this system.

Methodology

Research purpose

This research examined the effect of a supported employment program, utilizing a cost-benefit ratio approach. The specific purposes of this study were the following: First, it analyzed characteristics of supported employment participants in the Seoul West Rehabilitation Center. Second, it examined the outcomes of the supported employment program, such as wages and taxes. Finally, it scrutinized the cost-benefit ratios based on the perspectives of society, taxpayers, and the supported employees.

Framework of data analysis

Development of the cost-benefit analysis framework is based upon the accounting model of Thornton (1985) as described in a previous section. Components of the analysis are divided into the benefit and the cost based on the three analytic perspectives of society, the taxpayer, and persons with disabilities or the supported employees. All data are based on the years 1996, 1997, and 1998.

The analysis is composed of three basic elements within each category of benefit and cost in a 2 by 3 matrix. Values on each of the six areas were calculated for each of the three years. Benefits are analyzed by service user, tax transfer and program savings. Costs are analyzed by program costs and fees or transfer payment.

Transfer payment is based on the payment component. A payment can be either a benefit or a cost. For example, taxes, government subsidies, and program fees can be net costs in the perspective of society, while these costs can be considered as net benefits from the perspective of employees. The opportunity cost is a previous income, which was given up by having a new income such as; the previous income in sheltered work given up to receive the new income from supported employment. The method of analysis, from the three perspectives, applied a plus sign (+) as indicative of a net benefit, while a minus sign (-) is indicative of a net cost.

Data gathering procedures

Cost-benefit analysis was conducted based on data from a supported employment program in Seoul West Rehabilitation Center with 66 clients served for three years.

First, demographic characteristics of the participants such as gender and age variables were analyzed. Second, program outputs and the six cost-benefit components were also analyzed. Finally, based on the findings, benefits and costs were calculated in the context of the three perspectives of society, taxpayers and supported employees. Analyzing costs, due to the fact that the interest rate in developing countries is relatively high, a mathematical adjustment was done using current cost components, and the inflation rate was determined by modifying Hallak's (1981) formula as follows:

(c1 + c2/1+r + c3/[(1+r).sup.2]), where c1, c2, and c3 are the costs incurred in the years 1 to 3, and "r" as an interest rate.

From the perspective of society, the analysis was conducted by comparing the earnings of 66 clients with the supported employment's program cost, reflecting what they would have earned in an alternative program and the costs that would have been incurred. The alternative program was a sheltered employment program carried out by the same institute, Seoul West Rehabilitation Center with 20 clients with similar disabling conditions. From the taxpayer's perspective, savings of expenditures in the alternative program, program fees and payroll taxes were compared with expenditures of the supported employment program for the analysis. The taxpayers' perspective was compared with monetary outputs of the supported employment program; payroll taxes paid by supported employees, program fees, and earnings in the alternative program were analyzed from the supported employee's perspective. Further supplemental data were provided from the staff members, account books, and annual balance sheets were also used in the analysis.

Results

Participants

A majority of the participants (62%) are under the age of 30. Additionally, all participants were diagnosed mentally retarded (developmentally disabled): 30 participants with the second class, and 36 participants with the third class of legal mental retardation based on Korean standards. The Korean rehabilitation system uses a categorical approach to mental retardation as divided into three classes; IQ score under 34 plus difficulty with adjustment to social life (category 1), IQ score between 35 and 49 and trainable in one or more of vocational skill areas (category 2), IQ score between 50 and 70 and independent social life through training (category 3). Based on this system, the first category of legal mental retardation is the most severe disability. Therefore, it is apparent that this program targets people with mild and moderate disabilities.

Employment sites

The largest group of participants in supported employment over the three-year span was placed in the textile and fiber industry: 17 persons or 31.5%. The next largest group was placed in the bookbinding industry: 10 persons (18.5%). Next, in order of placement, are the service industry, packing, food manufacture, electronic assembly, and others. In the year 1998, the majority of participants were placed in the textile and fiber industries reflecting the characteristics of the local community where these individuals live.

Participant outcome

As shown in table 1, 66 persons earned a total of 110.3 million Won (Korean dollar) for the three years (an average of 4,901 thousand Won per person), one million US dollars approximately.

From 1996 to 1997, the average salary rose from 809,000 Won to 2.184 million Won, an increase of 270%. In 1998, salaries of participants fell by 9.5% compared to the previous year yet it remained 240% above the 1996 earnings. The supported employment program appeared effective, but the reason the figures for 1998 are somewhat disappointing has to do with the general economic depression experienced in Korea at that time. Labor statistics in Korea show that the average wage increase of industrial workers during 1998 was -2.5%, showing the first decreasing trend since 1970. In 1998, the average monthly wage per worker in all industries was 1,427,000 Won, while in 1997 it was 1,463,000 Won.

Alternative program cost

The total cost of sheltered workshop programs in 1996, 1997, and 1998 is about 76.8 million Won. Personnel expenses are the largest portion of cost (67.4%); while operational expenses are the second (22.4%) and property formation expenses (10.2%) are third. Personnel expense A (see table 2) is for the gross yearly income of staff members of the supported employment program. Personnel expense B is for managers and C is for the executive director. The yearly average input cost per program participant was approximately 853 thousand Won. The gross net cost of the alternative program of 66 participants was 56,569 thousand Won.

Supported employment program cost

As shown in table 2, the total cost of 66 participants was 82.9 million Won. The personnel expense is the largest cost item consisting of 77.2% of the total cost. The property formation expense is incurred only in the first year of the program due to the purchase of transportation.

Alternative program outcome

The yearly outcome per participant in the alternative program was 568 thousand Won in 1996, 616 thousand Won in 1997, and 517 thousand Won in 1998. Therefore, the total outcome for the three years was 1,701 thousand Won. The gross outcome of the alternative program was 11,360 thousand Won in 1996, 14,168 thousand Won in 1997, and 11,891 thousand Won in 1998. The total calculated outcome was 37,419 thousand Won (see table 1).

Cost-benefit from social perspective

The average benefit-cost ratio for the three years from the social perspective is 1.39 which includes employee out come (+), Employee tax paid, and program savings compared to the cost of the SE program (-), Program fee, and outcome of alternative program (-). However, the ratios per fiscal year increased by 0.77 in 1996, 1.59 in 1997, and 1.84 in 1998. This trend existed because costs of the Supported Employment program were decreasing as time went by. In summary, the supported employment program resulted in a cost-benefit ratio of 1.39 and a net benefit of 46,542 thousand Won. Thus, in a three-year period, expenses of 120.3 million Won brought a benefit of 166.9 million Won.

Cost-benefit for taxpayer

The cost-benefit ratio for the three years from the taxpayer perspective was 0.72 based on the analysis that the input cost of the program is compared with the sum of employees' taxes paid, program fees, and the savings of alternative program costs. The ratio (B/C) per fiscal year has been increasing, 0.54 in 1996, 0.72 in 1997, and 0.93 in 1998, respectively. This phenomenon shows that the costs put into the supported employment program were decreasing, while the saving in costs of the alternative program were increasing. This resulted in a net benefit increase from year to year.

Cost-benefit for participants

Comparing taxes paid by the employees, program fees, and the other opportunity costs with the outcome of supported employment carries out cost-benefit analysis from the participants' perspective. Therefore, costs of the alternative program, and the supported employment program are excluded from analysis. The average cost-benefit ratio is 2.58 to 1 for three years of the study. The ratio per fiscal year increased annually from: 1.24 to 1 in 1996, 3.13 to 1 in 1997, and 3.44 to 1 in 1998. On average, each supported employment participant earned 4,901 thousand Won for the three years. Therefore, the net benefit obtained is 3,000 thousand Won after subtracting the opportunity cost of 1,901 thousand Won which is composed of program fees and the alternative outcome.

Summary, Implications and Discussion

From a social perspective, the supported employment program required 120,327 thousand Won for the 66 participants, but earned 166,869 thousand Won for the three years. The benefit was, therefore, 46,542 thousand Won and the calculated cost-benefit ratio was 1.39 to 1. The taxpayer received a return of 56,569 thousand Won for 78,552 thousand Won invested over the three years. The taxpayer paid an additional 21,983 thousand Won for this period, so the cost-benefit ratio was 0.72, which is the lowest ratio of return on investment. From the perspective of employees, the average annual earning of each participant was 4,901 thousand Won for the three years. By subtracting 1,901 thousand Won, which was the sum of program fees and the opportunity cost of alternative programs, from the above annual earning, 3,000 thousand Won was generated as a net benefit.

The supported employment program in Seoul West Rehabilitation Center during the past three years provided economic gains from both the perspective of society and the employee, although it revealed a loss from the taxpayer's perspective. Compared with the expenditures of the first year of supported employment, those of the following two years decreased. The benefits, net benefits, and cost-benefit ratios all showed gradual increases during this specific period of time. The results of this study suggest that supported employment programs can be valuable as a vocational rehabilitation policy, particularly in the long term.

Many rehabilitation programs and facilities were established by the initiatives of the central Korean government. As such the quality and quantity of services will need to be examined to validate the efficiency and effectiveness of such programs. A primary question to resolve has to do with efficiency versus effectiveness. Services must be effective and beneficial to those who receive them and efficient to those who pay for them. The determination of the invisible value for social service programs in general is not an easy task (Royse, 1995; Mithaug, 1996). Balancing client self-determination rights and the level of care should not betaken lightly when making decisions regarding the efficiency and effectiveness of rehabilitation programs. In this regard, cost-benefit analysis should be viewed as one of several tools to be implemented when considering program evaluation.

Supported employment programs tend to be smaller, more community oriented and flexible when compared to other vocational rehabilitation programs. Movement from larger uniform institutions to community-based programs can provide a more responsive system with a multitude of options and alternatives.

Disability legislation can be an important factor in changing the public's attitude toward people with disabilities. Incorporating the family in decisions regarding family members and services is highly valued among Asian societies. Therefore institutional policies and legislative efforts need to include family as an important element in the decisions to develop services for and with persons with disabilities. Program cost, effectiveness and efficiency all need to be approached with a collective sense' of the society and the family from the Asian perspective. The cost-benefit model can help to provide an important decision point within the complex mixture of government, institutions, family, society, and people with disabilities.

Table 1

Outcome of Supported Employment & Alternative Program Outcome

(Unit: thousand Won)

Category                            1996      1997

Outcome of supported employment
Number                                  20         23
Total outputs (Won)                 16,180     49,400
Yearly outcome per client              809      2,148
Monthly outcome per client              67        179
Outcome increase                        --    +165.5%
Alternative program outcome
Monthly outcome per person              47         51
Estimated alternative outcome
  Per person                           568        616
  Number                                20         23
  Total                             11,360     14,168

Category                            1998      Total

Outcome of supported employment
Number                                  23         66
Total outputs (Won)                 44,720    110,300
Yearly outcome per client            1,944      4,901
                                              (Monthly
                                              average
                                              1,671)
Monthly outcome per client             162    (Monthly
                                              average 139)
Outcome increase                     -9.5%    --
Alternative program outcome
Monthly outcome per person              43    Average 47
Estimated alternative outcome
  Per person                           517      1,701
  Number                                23         66
  Total                             11,891     37,419

Table 2

Alternative Program Cost & Supported Employment Program Cost

(Unit: thousand Won)

Category                          1996     1997     1998     Total

Alternative program cost
1. Number                             30       30       30        90
2. Administrative cost
 * Personnel expense A            11,212   13,528   14,922    39,662
     B                             2,500    3,060    3,150     8,710
     C                               695      930    1,075     2,700
 * Sub total                      14,407   17,518   19,147    51,072
 * Operational cost                5,417    5,659    6,086    17,162
3. Property formation expense      2,838    2,838    2,838     8,514
4. Total                          22,662   26,015   28,071    76,748
5. Estimated alternative program cost after adjustment
 * Cost per person                   755      867      936     2,558.4
 * Number                             20       23       23        66
 * Total                          15,100   19,941   21,528    56,569

Supported employment program cost
1. Number                             20       23       23        66
2. Administrative cost
 * Personnel expense              19,474   24,686   19,789    63,949
 * Operational cost                4,724    4,701    4,334    13,759
3. Property expense                5,200        0        0     5,200
4. Total                          29,398   29,387   24,123    82,908
5. Cost per person                 1,470    1,278    1,049     3,797
                                                             (average)
                                                             1,265)

Acknowledgement

This work was supported by a Daegu University Research grant (20029200).

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Dal-Yob Lee
Byung-Ju Yoo
Daegu University

Robert Peters, Ph.D., University of Wisconsin-Stout, Department of Rehabilitation and Counseling, 232 Vocational Rehabilitation Building, Menomonie, WI. 54751. Email: [e-mail]