Abstract
The central question addressed in this dissertation is: What choices do people with a physical disability make regarding their support and to what extent do differences in individual background characteristics and local authority policy play a role in those choices? The main focus is on informal and formal support provided
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under the Dutch Social Support Act (Wmo). The Wmo operates at the level of national policy, as laid down in the Act itself; at the level of local authority policy; and the level of the interaction between (local authority) providers and those who register with them for support. This study used theoretical models covering these three levels. The Wmo charges local authorities with supporting informal carers and states that recipients of Wmo-funded support must in principle be given the choice of receiving that support in kind or in the form of a personal budget. Responsibility for the specific details of Wmo policy and implementation, including the policy in relation to informal help and personal budgets, was placed on local authorities. The rationale was that they were close to citizens and would therefore be able to provide more person-centred support than the national government. This dissertation examines the three main options available to people with disabilities in the process of choosing social support: (1) whether or not to make use of support; (2) whether to opt for informal or formal support or a combination of the two; and (3) whether to receive support in kind or in the form of a personal budget. These options and choices were investigated in five studies. The studies show that differences in local authority policy have virtually no influence on the choices made by people with disabilities. One exception to this finding is the degree to which local authorities inform applicants for Wmo support about the possibility of a personal budget. We regard the fact that many applicants were not (clearly) informed, that there are systematic differences across local authorities in how well informed applicants are, and that this influences access to support, as an unintended consequence of the Wmo. Another result: no significant effects of the personal budget were found. People with a personal budget experience no better independence, participation in society and quality of life than comparable people using conventionally organised help. The strengths of this research are its policy relevance, the combination of a range of analytical methods and techniques, and the linking of policy data to client data. Each of the studies also has limitations, mainly relating to the data collection. The data used were drawn from individual studies of the first and second Wmo evaluations and were not specifically designed to answer the questions addressed in this dissertation.
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