[Low-value care requires adequate financial constraints: preconditions to render low-value care as an effective instrument in health care transformation]. / Passende zorg vereist passende sturing.

The accessibility and affordability of good quality health care is increasingly under pressure. 'Passende zorg' may support health care organisations and care providers in achieving the much needed transformation in health care. For 'Passende zorg' to be an effective instrument, adequate financial conditions are a prerequisite. In this paper, we point at the importance of firm embedding of 'Passende zorg' in a hospital's business operations to yield effect.

Perspective of relatives on restrictions applied to their family members with moderate intellectual disability.

The application of restrictions plays a great part in daily support of people with moderate intellectual disability (ID). In this study we examine the evaluation of relatives of restrictions applied to their family members with moderate ID. Relatives are key and permanent figures in the lives of people with moderate intellectual disability. Moreover, relatives in their role as representatives are authorized to make decisions in case people with moderate ID are not able to oversee the consequences of their actions. To explore relatives' evaluation of restrictions, we conducted semi-structured interviews with 10 relatives. Qualitative analysis was carried out using a thematic approach. We found that respondents consider restrictions necessary when they promote physical well-being, safety and indistinctive, 'normal', appearance of their family members with ID. In applying these restrictions a 'rules are rules' and a 'tailor-made rules' approach can be discerned. The 'tailor-made approach' provides space for dialogue with people with moderate ID. In this dialogue the criteria of proportionality, effectiveness, and subsidiarity are helpful. In using these criteria, the application of a restriction has to be in proportion, has to lead to the desired effect, and, finally, should be as unintrusive as possible for the person concerned. As such, it is recommended that, in dialogue, support staff, people with moderate ID themselves, and their relatives seek ways to examine what kinds of restrictions are justified for people with moderate ID.

The value of competitive employment: In-depth accounts of people with intellectual disabilities.

BACKGROUND: Increasing the societal participation of people with intellectual disabilities via competitive employment requires a full understanding of what this means to them. This paper aims to provide an in-depth examination of the lived experiences of people with intellectual disabilities in competitive employment. METHOD: Interviews were conducted with six participants with mild intellectual disability or borderline functioning and good verbal communication skills. Interviews were analysed according to the guidelines of interpretative phenomenological analysis (IPA). Member checks were conducted. RESULTS: Analysis yielded three main themes: (a) Building on my life experiences, (b) My place at work and (c) Being a valuable member of society, like everyone else. CONCLUSIONS: Competitive employment could make a substantial contribution to the sense of belonging to society and quality of life of people with intellectual disabilities. Nevertheless, they must cope with stigma-related obstacles and feelings of being dependent on others in the work environment.