The relationship of personal budgets with independence, participation and quality of life; a secondary analysis of survey data using propensity score matching.

OBJECTIVES: Personal budgets for social and health care have been introduced in many European countries over recent decades. The assumption is that people with a personal budget are able to purchase care that matches their needs more closely and therefore experience greater independence and improved well-being. The question is whether this assumption is true. Little research has been carried out on this and the research that has been carried out is inconclusive and hampered by methodological limitations. METHODS: We performed a secondary analysis of data collected in a survey among persons who had submitted an application for social support. Propensity score matching was used to investigate whether people with a personal budget experience better independence, participation in society and quality of life than comparable people using conventionally organised help. RESULTS: After matching, no significant effects of the personal budget were initially found. A sensitivity analysis that excluded the variable sense of mastery from the calculation of the propensity scores, showed a significantly greater independence for those using a personal budget. CONCLUSION: There may be several reasons for this lack of effect. First, perhaps there are no effects. It is also possible that effects can only be found in specific situations and/or specific groups.

Influence of municipal policy and individual characteristics on the use of informal and formal domestic help in the Netherlands.

BACKGROUND: The responsibility for care and social support in the Netherlands has been decentralized to the municipalities, on the assumption that they are able to organise care and social support more effectively and efficiently. Municipalities are responsible for offering citizens the social support they need. They have policy discretion to decide how and to what extent they encourage and support the use of informal help. This article explored whether the local policy focus on informal or formal help influences the actual take-up of domestic help. METHODS: Data on 567 physically disabled people who use informal or formal help in the household were linked to local policy data in 167 municipalities. We performed multilevel multinomial regression analyses. Since we expected that local policy will have more influence on people with slight or moderate disabilities, cohabitees and people aged under 75, cross-level interaction terms were included between characteristics of local policy and of individuals. RESULTS: The findings reveal differences between municipalities in their policy on support and differences in the use of formal or informal support between municipalities. CONCLUSIONS: We found no relationship between local emphasis on informal help and the use of informal help. Possible explanations: some people have a small social network, people using informal help did not apply for municipality support or even do not know the possibility exists.