No-shows in appointment scheduling – a systematic literature review

May 4, 2018, 6:39 am

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Publication date: April 2018
Source:Health Policy, Volume 122, Issue 4
Author(s): Leila F. Dantas, Julia L. Fleck, Fernando L. Cyrino Oliveira, Silvio Hamacher
No-show appointments significantly impact the functioning of healthcare institutions, and much research has been performed to uncover and analyze the factors that influence no-show behavior. In spite of the growing body of literature on this issue, no synthesis of the state-of-the-art is presently available and no systematic literature review (SLR) exists that encompasses all medical specialties. This paper provides a SLR of no-shows in appointment scheduling in which the characteristics of existing studies are analyzed, results regarding which factors have a higher impact on missed appointment rates are synthetized, and comparisons with previous findings are performed. A total of 727 articles and review papers were retrieved from the Scopus database (which includes MEDLINE), 105 of which were selected for identification and analysis. The results indicate that the average no-show rate is of the order of 23%, being highest in the African continent (43.0%) and lowest in Oceania (13.2%). Our analysis also identified patient characteristics that were more frequently associated with no-show behavior: adults of younger age; lower socioeconomic status; place of residence is distant from the clinic; no private insurance. Furthermore, the most commonly reported significant determinants of no-show were high lead time and prior no-show history.

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Implementing the medicines reconciliation tool in practice: challenges and opportunities for pharmacists in Kuwait

May 4, 2018, 6:39 am

≫ Next: Assessing the effect of standardized cost systems on financial performance. A difference-in-differences approach for hospitals according to their technological level

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Publication date: April 2018
Source:Health Policy, Volume 122, Issue 4
Author(s): Maram G. Katoue, Jean Ker
Background Using the medicines reconciliation tool which involves preparing an updated list of patient’s medications at each transition of care can significantly enhance patient safety. The pharmacist has been leading this process in western healthcare systems. Little is known about pharmacists’ role in medicines reconciliation in Middle Eastern Countries. Objectives To explore the implementation of medicines reconciliation in Kuwait hospitals, pharmacists’ role in this process and perceptions of the challenges in implementing it in practice. Methods This was an exploratory descriptive study of medicines reconciliation practices at eleven secondary/tertiary hospitals in Kuwait. A mixed-methods research design was used whereby 110 hospital pharmacists participated in 11 focus groups and 88 of them completed self-administered surveys. Results Participants reported that medicines reconciliation is poorly applied in hospitals and that they had limited role in the process. The current medicines reconciliation policy does not assign any responsibilities for pharmacists in this process. The most significant barriers to applying medicines reconciliation by pharmacists were inadequate staff numbers, lack of time, difficult access to patient information, lack of policy to support pharmacist role and patients’ poor knowledge about their medications. Conclusions Hospital pharmacists in Kuwait advocate implementing medicines reconciliation but report significant strategic/operational barriers to its application. Efforts are needed in policy reform and team training to enable pharmacists provide effective patient care services including medicines reconciliation.

Assessing the effect of standardized cost systems on financial performance. A difference-in-differences approach for hospitals according to their technological level

May 4, 2018, 6:39 am

≫ Next: Stakeholder views on the role of spiritual care in Australian hospitals: An exploratory study

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Publication date: April 2018
Source:Health Policy, Volume 122, Issue 4
Author(s): Beatriz García-Cornejo, José A. Pérez-Méndez
Promoting the improvement of standardized cost systems (CS) is one of the measures available to health policy makers for the purpose of improving efficiency in hospitals over the long-term. Nevertheless, very few studies evaluate the relationship between alternative CS and the costs really incurred. We use data from 242 hospitals of the Spanish National Health Service (NHS) between 2010 and 2013 in order to explore the determinants of the cost per adjusted patient day, using a difference-in-differences approach where the treatment is the implementation of an advanced CS. We also investigate if the association between advanced CS and unit cost is different depending upon the technological level of the hospital. Results show that hospitals with more advanced CS contained their costs better. However, the latter effect of advanced CS is lower in hospitals with a greater endowment of high technology. Results suggest that health authorities should support the development of CS, particularly in high-tech hospitals, which are usually larger and more complex hospitals that tend to accumulate a greater portion of NHS hospital sector expenditure.

Stakeholder views on the role of spiritual care in Australian hospitals: An exploratory study

May 4, 2018, 6:39 am

≫ Next: Health policies for the reduction of obstetric interventions in singleton full-term births in Catalonia

≪ Previous: Assessing the effect of standardized cost systems on financial performance. A difference-in-differences approach for hospitals according to their technological level

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Publication date: April 2018
Source:Health Policy, Volume 122, Issue 4
Author(s): Cheryl Holmes
Research increasingly demonstrates the contribution of spiritual care to patient experience, wellbeing and health outcomes. Responsiveness to spiritual needs is recognised as a legitimate component of quality health care. Yet there is no consistent approach to the models and governance of spiritual care across hospitals in Australia. This is consistent with the situation in other developed countries where there is increased attention to identifying best practice models for spiritual care in health. This study explores the views of stakeholders in Australian hospitals to the role of spiritual care in hospitals. A self-completion questionnaire comprising open and closed questions was distributed using a snowball sampling process. Analysis of 477 complete questionnaires indicated high levels of agreement with ten policy statements and six policy objectives. Perceived barriers to spiritual care related to: terminology and roles, education and training, resources, and models of care. Responses identified the issues to inform a national policy agenda including attention to governance and policy structures and clear delineation of roles and scope of practice with aligned education and training models. The inclusion of spiritual care as a significant pathway for the provision of patient-centred care is noted. Further exploration of the contribution of spiritual care to wellbeing, health outcomes and patient experience is invited.

Health policies for the reduction of obstetric interventions in singleton full-term births in Catalonia

May 4, 2018, 6:39 am

≫ Next: Unplanned admissions to inpatient psychiatric treatment and services received prior to admission

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Publication date: April 2018
Source:Health Policy, Volume 122, Issue 4
Author(s): Maria-Jesus Pueyo, Ramon Escuriet, M. Pérez-Botella, I. de Molina, D. Ruíz-Berdun, S. Albert, S. Díaz, P. Torres-Capcha, V. Ortún
Aim To explore the effect of hospital's characteristics in the proportion of obstetric interventions (OI) performed in singleton fullterm births (SFTB) in Catalonia (2010–2014), while incentives were employed to reduce C-sections. Methods Data about SFTB assisted at 42 public hospitals were extracted from the dataset of hospital discharges. Hospitals were classified according to the level of complexity, the volume of births attended, and the adoption of a non-medicalized delivery (NMD) strategy. The annual average change in the percentage for OI was calculated based on Poisson regression models. Results The rate of OI (35% of all SFTB) including C-sections (20.6%) remained stable through the period. Hospitals attending less complex cases had a lower average of OI, while hospitals attending lower volumes had the highest average. Higher levels of complexity increased the use of C-sections (+4% yearly) and forceps (+16%). The adoption of the NMD strategy decreased the rate of C-sections. Conclusions The proportion of OI, including C-sections, remained stable in spite of public incentives to reduce them. The adoption of the NMD strategy could help in decreasing the rate of OI. To reduce the OI rate, new strategies should be launched as the development of low-risk pregnancies units, alignment of incentives and hospital payment, increased value of incentives and encouragement of a cultural shift towards non-medicalized births.

Unplanned admissions to inpatient psychiatric treatment and services received prior to admission

May 4, 2018, 6:39 am

≫ Next: The impact of the financial crisis and austerity policies on the service quality of public hospitals in Greece

≪ Previous: Health policies for the reduction of obstetric interventions in singleton full-term births in Catalonia

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Publication date: April 2018
Source:Health Policy, Volume 122, Issue 4
Author(s): Solveig Osborg Ose, Jorid Kalseth, Marian Ådnanes, Tone Tveit, Solfrid E. Lilleeng
Background Inpatient bed numbers are continually being reduced but are not being replaced with adequate alternatives in primary health care. There is a considerable risk that eventually all inpatient treatment will be unplanned, because planned or elective treatments are superseded by urgent needs when capacity is reduced. Aims of the study To estimate the rate of unplanned admissions to inpatient psychiatric treatment facilities in Norway and analyse the difference between patients with unplanned and planned admissions regarding services received during the three months prior to admission as well as clinical, demographical and socioeconomic characteristics of patients. Method Unplanned admissions were defined as all urgent and involuntary admissions including unplanned readmissions. National mapping of inpatients was conducted in all inpatient treatment psychiatric wards in Norway on a specific date in 2012. Binary logit regressions were performed to compare patients who had unplanned admissions with patients who had planned admissions (i.e., the analyses were conditioned on admission to inpatient psychiatric treatment). Results Patients with high risk of unplanned admission are suffering from severe mental illness, have low functional level indicated by the need for housing services, high risk for suicide attempt and of being violent, low education and born outside Norway. Conclusion Specialist mental health services should support the local services in their efforts to prevent unplanned admissions by providing counselling, short inpatient stays, outpatient treatment and ambulatory outpatient psychiatry services. Implications for health policies This paper suggests the rate of unplanned admissions as a quality indicator and considers the introduction of economic incentives in the income models at both service levels.

The impact of the financial crisis and austerity policies on the service quality of public hospitals in Greece

May 4, 2018, 6:39 am

≫ Next: Socioeconomic status and waiting times for health services: An international literature review and evidence from the Italian National Health System

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Publication date: April 2018
Source:Health Policy, Volume 122, Issue 4
Author(s): Ioanna Keramidou, Loukas Triantafyllopoulos
The influence of the financial crisis on the efficiency of Greek public hospitals has been widely debated. Despite this increasing interest in such research, the question of to what extent the recent reforms in the Greek National health care system were effective in establishing a health care structure and process that provide better results for patients has yet to be fully investigated. As a step in this direction, the paper focuses on patient's experience with public hospital care quality before and during the economic crisis. A questionnaire survey was carried out among 1872 patients discharged from 110 out of the total of 124 Greek public hospitals. Patients' perceptions were analysed using a structural equation modelling approach. The findings reveal that public hospital service quality is at a medium level (66.2 on a scale from 1 to 100) over 2007–2014, presenting a decreasing trend during the recession. Policies to address the crisis may have contributed to a reduction in hospital expenditures, but at the same time patients were increasingly dissatisfied with the technical care. Consequently, there is a need for reforms aimed at the achievement of productivity gains, responsibility, and transparency in the management of productive resources, by enabling health organisations to reduce their costs without a deterioration in the quality of care.

Socioeconomic status and waiting times for health services: An international literature review and evidence from the Italian National Health System

May 4, 2018, 6:39 am

≫ Next: Control of hospitals and nursing homes in France: The 2016 reform may indirectly improve a dysfunctional system

≪ Previous: The impact of the financial crisis and austerity policies on the service quality of public hospitals in Greece

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Publication date: April 2018
Source:Health Policy, Volume 122, Issue 4
Author(s): Stefano Landi, Enrico Ivaldi, Angela Testi
In the absence of priority criteria, waiting times are an implicit rationing instrument where the absence or limited use of prices creates an excess of demand. Even in the presence of priority criteria, waiting times may be unfair because they reduce health care demand of patients in lower socio-economic conditions due to high opportunity costs of time or a decay in their health level. Significant evidence has shown a relationship between socioeconomic status and the length of waiting time. The first phase of the study involved an extensive review of the existent literature for the period of 2002–2016 in the main databases (Scopus, PubMed and Science Direct). Twenty-eight met the eligibility criteria. The 27 papers were described and classified. The e mpirical objective of this study was to determine whether socioeconomic characteristics affect waiting time for different health services in the Italian national health system. The services studied were specialist visits, diagnostics tests and elective surgeries. A classification tree and logistic regression models were implemented. Data from the 2013 Italian Health National Survey were used. The analysis found heterogeneous results for different types of service. Individuals with lower education and economic resources have a higher risk of experiencing excessive waiting times for diagnostic and specialist visits. For elective surgery, socioeconomic inequalities are present but appear to be lower.

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Control of hospitals and nursing homes in France: The 2016 reform may indirectly improve a dysfunctional system

May 4, 2018, 6:39 am

≫ Next: Hospital centralization and performance in Denmark—Ten years on

≪ Previous: Socioeconomic status and waiting times for health services: An international literature review and evidence from the Italian National Health System

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Publication date: April 2018
Source:Health Policy, Volume 122, Issue 4
Author(s): Sandra Bertezene
In France, the supervisory bodies require hospitals and nursing homes to undergo various control procedures. A stack of legislation and control measures has piled up, with no provision for their interconnection being included in any of the legislation. The purpose of the article is to point to the prospects for better control opened up by the legislation modernising the health system adopted on 26 January 2016. The reform will neither directly change the partitioning between the supervisory bodies preventing the sharing of information and the harmonisation of the practices in terms of control, nor change the internal partitioning within the supervisory body. But in hospitals, the reform will improve the interconnection of control of quality/control inspections/control of strategy using a common medical project and pooling certain cross-cutting functions, and implementing the control of quality for the new local hospital groupings as a whole. In nursing homes, the generalisation of multi-year aims and means contracts would allow a better interconnection of the control of strategy and the control of quality since it provides managers with the means of constructing projects for the evolution of their establishments over a period of time, and accompanies changes in the socio-medical offer to improve the provision of care. These changes would allow a more credible, coherent, useful, and equitable control.

Hospital centralization and performance in Denmark—Ten years on

May 4, 2018, 6:39 am

≫ Next: Editorial Board

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Publication date: April 2018
Source:Health Policy, Volume 122, Issue 4
Author(s): Terkel Christiansen, Karsten Vrangbæk
Denmark implemented a major reform of the administrative and political structure in 2007 when the previous 13 counties were merged into five new regions and the number of municipalities was reduced from 271 to 98. A main objective was to create administrative units that were large enough to support a hospital structure with few acute hospitals in each region and to centralize specialized care in fewer hospitals. This paper analyses the reorganization of the somatic hospital sector in Denmark since 2007, discusses the mechanisms behind the changes and analyses hospital performance after the reform. The reform focused on improving acute services and quality of care. The number of acute hospitals was reduced from about 40–21 hospitals with new joint acute facilities, which include emergency care wards. The restructuring and geographical placement of acute hospitals took place in a democratic process subject to central guidelines and requirements. Since the reform, hospital productivity has increased by more than 2 per cent per year and costs have been stable. Overall, indicators point to a successful reform. However, it has also been criticized that some people in remote areas feel “left behind” in the economic development and that hospital staff are under increased workload pressure. Concurrent with the centralization of hospitals municipalities strengthened their health service with an emphasis on prevention and health promotion.

Editorial Board

May 4, 2018, 6:39 am

≫ Next: Pathways to DRG-based hospital payment systems in Japan, Korea, and Thailand

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Publication date: April 2018
Source:Health Policy, Volume 122, Issue 4

Pathways to DRG-based hospital payment systems in Japan, Korea, and Thailand

May 7, 2018, 12:59 pm

≫ Next: Advancing Indigenous Primary Health Care Policy in Alberta, Canada

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Publication date: Available online 7 May 2018
Source:Health Policy
Author(s): Peter Leslie Annear, Soonman Kwon, Luca Lorenzoni, Stephen Duckett, Dale Huntington, John C. Langenbrunner, Yuki Murakami, Changwoo Shon, Ke Xu

Advancing Indigenous Primary Health Care Policy in Alberta, Canada

May 7, 2018, 12:59 pm

≫ Next: Personal health records, global policy and regulation review

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Publication date: Available online 7 May 2018
Source:Health Policy
Author(s): Rita Henderson, Stephanie Montesanti, Lindsay Crowshoe, Charles Leduc
For Indigenous people worldwide, accessing Primary Health Care (PHC) services responsive to socio-cultural realities is challenging, with institutional inequities in healthcare and jurisdictional barriers encumbering patients, providers, and decision-makers. In the Canadian province of Alberta, appropriate Indigenous health promotion, disease prevention, and primary care health services are needed, though policy reform is hindered by complex networks and competing interests between: federal/provincial funders; reserve/urban contexts; medical/allied health professional priorities; and three Treaty territories each structuring fiduciary responsibilities of the Canadian government. In 2015, the Truth and Reconciliation Commission (TRC) of Canada released a final report from over six years spent considering impacts of the country's history of Indian residential schools, which for more than a century forcibly removed thousands of children from their families and communities. The TRC directed 94 calls to action to all levels of society, including health systems, to address an historical legacy of cultural assimilationism against Indigenous peoples. To address TRC calls that Indigenous health disparities be recognized as resulting from previous government policies, and to integrate Indigenous leadership and perspectives into health systems, PHC decision-makers, practitioners, and scholars in the province of Alberta brought together stakeholders from across Canada. The gathering detailed here explored Indigenous PHC models from other Canadian provinces to collaboratively build relationships for policy reform and identify opportunities for PHC innovations within Alberta.

Personal health records, global policy and regulation review

May 22, 2018, 3:51 pm

≫ Next: A Multilevel Analysis of the determinants of emergency care visits by the elderly in France

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Publication date: Available online 14 May 2018
Source:Health Policy
Author(s): Yakov Flaumenhaft, Ofir Ben-Assuli
Personal health records (PHR) have been endorsed as a promising tool for the self-management of an individual's medical information, affording benefits to both the individual patient and the healthcare system as a whole. Nevertheless, adoption rates have been relatively slow and widespread acceptance has yet to be achieved. A significant obstacle often cited as delaying the implementation of these systems has been concern regarding the ability to properly ensure the security and privacy of this sensitive information. This article reviews the current legislative landscape in various countries, examining the degree to which they address these issues and support the implementation of PHR's. This review compares in particular a number of prominent components of health data security and privacy across five different legislative jurisdictions in order to allow for a closer examination of regulatory approaches and measures. Of the legislation reviewed the EU's GDPR stands out as providing the most comprehensive and stringent protection measures, yet nonetheless seems to leave significant room for interpretation and a degree of ambiguity in key areas. The results of this comparison, demonstrate considerable variances with regards to legal terminology and the degree of compliance required from entities offering PHR services across various jurisdictions. The paper ends with a discussion of specific policy implications and recommendations stemming from the current legislative state of affairs.

A Multilevel Analysis of the determinants of emergency care visits by the elderly in France

May 22, 2018, 3:51 pm

≫ Next: The Americanization of the British National Health Service: A Typological Approach

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Publication date: Available online 18 May 2018
Source:Health Policy
Author(s): Zeynep Or, Anne Penneau
Background Rising numbers of visits to emergency departments (EDs), especially amongst the elderly, is a source of pressure on hospitals and on the healthcare system. This study aims to establish the determinants of ED visits in France at a territorial level with a focus on the impact of ambulatory care organisation on ED visits by older adults aged 65 years and over. Methods We use multilevel regressions to analyse how the organisation of healthcare provision at municipal and wider ‘department’ levels impacts ED utilisation by the elderly while controlling for the local demographic, socioeconomic and health context of the area in which patients live. Results ED visits vary significantly by health context and economic level of municipalities. Controlling for demand-side factors, ED rates by the elderly are lower in areas where accessibility to primary care is high, measured as availability of primary care professionals, out-of-hours care and home visits in an area. Proximity (distance) and size of ED are drivers of ED use. Conclusion High rates of ED visits are partly linked to inadequate accessibility of health services provided in ambulatory settings. Redesigning ambulatory care at local level, in particular by Improving accessibility and continuity of primary and social care services for older adults could reduce ED visits and, therefore, improve the efficient use of available healthcare resources.

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The Americanization of the British National Health Service: A Typological Approach

May 22, 2018, 3:51 pm

≫ Next: Universal coverage reforms in the USA: From Obama care through Trump

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Publication date: Available online 21 May 2018
Source:Health Policy
Author(s): Martin Powell, Daniel Beland, Alex Waddan
There have been many different claims that the British National Health Service (NHS) is becoming ‘Americanized’. Focusing on the United Kingdom, this article critically analyses the ‘Americanization’ of the NHS in three main sections. First, we explore the basic meanings of the term. Second, we examine the development of the discourse about Americanization. Third, we focus on one of many possible meanings of Americanization, namely system change. Focusing on the most demanding dimension of Americanization, namely system change, we suggest that most changes have been’ internal changes of levels’ (where there is a shift of levels in one or more dimensions but without changing the dominant form) or ‘internal system changes’ (where only one dimension changes its dominant form) rather than a ‘system change’ (from one ideal type to another).

Universal coverage reforms in the USA: From Obama care through Trump

May 22, 2018, 3:51 pm

≫ Next: Sláintecare – a ten-year plan for Irish health reform devised through political consensus

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Publication date: Available online 22 May 2018
Source:Health Policy
Author(s): Thomas Rice, Lynn Y. Unruh, Ewout van Ginneken, Pauline Rosenau, Andrew J. Barnes
Since the election of Donald Trump as President, momentum towards universal health care coverage in the United States has stalled, although efforts to repeal the Affordable Care Act (ACA) in its entirety failed. The ACA resulted in almost a halving of the percentage of the population under age 65 who are uninsured. In lieu of total repeal, the Republican-led Congress repealed the individual mandate to purchase health insurance, beginning in 2019. Moreover, the Trump administration is using its administrative authority to undo many of the requirements in the health insurance exchanges. Partly as a result, premium increases for the most popular plans will rise an average of 34% in 2018 and are likely to rise further after the mandate repeal goes into effect. Moreover, the administration is proposing other changes that, in providing states with more flexibility, may lead to the sale of cheaper and less comprehensive policies. In this volatile environment it is difficult to anticipate what will occur next. In the short-term there is proposed compromise legislation, where Republicans agree to provide funding for the cost-sharing subsidies if the Democrats agree to increase state flexibility in some areas and provide relief to small employers. Much will depend on the 2018 and 2020 elections. In the meantime, the prospects are that the number of uninsured will grow.

Sláintecare – a ten-year plan for Irish health reform devised through political consensus

May 22, 2018, 3:51 pm

≫ Next: Improving the forecasting of hospital services: a comparison between projections and actual utilization of hospital services

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Publication date: Available online 22 May 2018
Source:Health Policy
Author(s): Sara Burke, Sarah Barry, Rikke Siersbaek, Bridget Johnston, Maebh Ní Fhallúin, Steve Thomas
In May 2017, an Irish cross-party parliamentary committee published the ‘Houses of the Oireachtas Committee on the Future of Healthcare “Sláintecare” report’. The report known as ‘Sláintecare’ was unique and historic as it is the first time there has been a cross-party political consensus for major health reform in Ireland. Sláintecare sets out a high level policy road map roadmap to deliver whole system reform and universal healthcare, phased over a ten year period and costed. Sláintecare details reform proposals which, if delivered, will establish; a universal, single-tier health service where patients are treated solely on the basis of health need; the reorientation of the health system ‘towards integrated primary and community care, consistent with the highest quality of patient safety in as short a time-frame as possible’. Sláintecare has five interrelated components: population health, entitlements and access to healthcare; integrated care, funding. In this article, the authors use documents/materials in the public domain (parliamentary reports, public hearings, submissions to the Committee, media coverage, the final report of the Committee, speeches by Committee members) to describe the policy process and the main contents of the proposed Sláintecare reforms. It is too soon tell if the political consensus in the policy formation can hold for its implementation.

Improving the forecasting of hospital services: a comparison between projections and actual utilization of hospital services

May 25, 2018, 9:29 pm

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

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Publication date: Available online 24 May 2018
Source:Health Policy
Author(s): Nicolas Bouckaert, Koen Van den Heede, Carine Van de Voorde
Objectives To compare projected and observed hospital inpatient use in Belgium and to draw lessons from that comparison. Methods In 2005, projections for hospital service use were generated up to 2015, based on demographic change, substitution from inpatient to day care, and, the evolution of the average length of stay (LOS). The accuracy of the forecasts was assessed by comparing projected and observed population size, admissions and inpatient days, average LOS and percentage change in case mix. Results The demographic growth was underestimated. Overall, the baseline projection for hospital admissions was remarkably close to the observed figures but the underlying case mix diverged importantly. With substitution between inpatient and day care, the number of admissions was underestimated by 15% to 40%. The number of days was projected to increase in every scenario, whereas a decreasing trend was observed mainly due to the faster decline in average LOS than projected. Conclusion Hospital capacity planning is an important component of evidence informed policymaking. Projection results benefit from a well-designed methodology: choice of forecast groups, estimation models, selection criteria, and a sensitivity analysis of the results. To cope with the dynamic and continuously evolving context in which hospitals operate, regular updates to incorporate new data and to reassess estimated trends should be an integral part of the projection framework.

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

May 25, 2018, 9:29 pm

≫ Next: What happens at the end of life? Using linked administrative health data to understand healthcare usage in the last year of life in New Zealand

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Publication date: Available online 24 May 2018
Source:Health Policy
Author(s): Anna Maria Marangos, Geeke Waverijn, Mirjam de Klerk, Jurjen Iedema, Peter P. Groenewegen
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.