Financial incentives for independent living

Friday, November 1, 2013
First author:
Harry van Haaster
Social Network & Public Policy

IGPB, Amsterdam, the Netherlands

All authors:

Harry van Haaster

Public Policy & Rigths
Developmental disability, adolescents, care givers


In Dutch policy development for healthcare a strong emphasis is made on market forces. Health care is seen as a market. Users of healthcare hardly have a market position. The only choices they can make for themselves and which are supported by laws,  are the free choice of providers and the free choice of insurance(company). Other laws, like those on healthcare decisions (WGBO) give users a right to refuse a proposal.
I want to defend a stronger position of users on the market by giving them much more possibilities to chose and decide.


A research project was done as part of a ZonMW disability studies program and was completed in 2012. Our research project was done with 59 respondents who have a personal budget to buy care and assistance for themselves. Qualitative interviews were done about what kind of care they buy, what kind of choices they make and how they want the care to be performed. Also family members and caregivers were interviewed. The interviews were analysed with methods of discourse analysis and narrative analysis.


Our research shows that users make decisions about 1) Who they prefer to give assistance, 2) When: during which part of the day they need it, 3) Where, the place of delivering assistance, 4) What should be done, 5) How it should be done,  6) How much assistance they need, and 7) Why they want certain assistance. In the process of delivering and accepting assistance, users are constantly fine tuning with the persons giving the assistance. he process both leads to empowerment and improved quality of existence.


The user is much more able than presumed in policy developments to act in an economically interesting way: When he knows what he pays, he has a choice to go for a more cheap choice. When he is economic he is able to save something for worse times or spare money for other things. Most of the times users do not want too much assistance or care. Less is often better. Often times users do not choose professionals as assistants. They prefer relatives or neighbours because these are more flexible and offer more social contact.
In these times of sky-high rising costs for healthcare and cuts on the budgets for healthcare, users are asked again and again to take their responsibility. Many users want to and can take this responsibility, but this responsibility must be triggered by financial incentives for private management and independent living.