Subject-oriented financing systems: Analysis and evaluation on current theory and practice

Project

Ausgangslage und Ziele

At the request of the Social Welfare Office of the Canton of Zug, the research project is to establish the basis for subject financing (Subjektfinanzierung). The aim of the project is to analyse and evaluate international experiences with subject financing systems for adult persons with disabilities.

In subject financing, financial payments are made by the cost bearer (for example, the canton) directly to persons receiving services according to their individual needs; the benefit recipients buy the services that they need. This replaces the former triangle in the health insurance laws (cost bearers – service providers – benefit recipients) and strengthens the role of the benefit recipient, giving recipients an active role as persons able to make choices and decisions.

There are various expectations connected with subject financing: from the viewpoint of special education, self-determination and from an economic perspective, a more efficient use of means. This accords with the mandate of the UN Convention on the Rights of Persons with Disabilities.

Project Management

Judith Adler lic. phil.

Facts

  • Duration
    08.2017
    12.2017
  • Project number
    3_23

Financial support

Question

  1. What have been the experiences with subject financing models in Switzerland and in European countries (success factors and difficulties)?
  2. What procedures and instruments are used to assess needs?

Methodical approach

The cross-country analysis is based on literature research, looking at evaluation reports on subject financing in Europe and in Switzerland (Canton of Bern, Canton of Basel, the Swiss Confederation). The topics examined are the following:

  1. Use of the personal budget by person with disabilities (description of the recipient; life situation, management of finances, need for support)
  2. How the personal budget works (eligibility for benefits; application procedures; proof of use, advisory services; quality control)
  3. Effects of the personal budget (satisfaction of budget recipients, development of service providers; costs; social impacts)

Results

Based on analysis of the research in Switzerland, Germany, Sweden, the Netherlands, and Great Britain, five cornerstones of a subject-oriented offer are formulated:

  1. Changed values: the attitude towards the value orientation on which the personal budget is based affects authorization practice.
  2. Service offerings: Support is needed to build up a differentiated range of support services, so that persons with disabilities have options from which to choose; not only the existing range of services should be assumed.
  3. Procedures for applying and for assessing needs: Person-centred needs assessment, for example using the concept of Integrated Participation Planning, requires a broader application of the concept, so that the support options do not remain limited to existing support offerings. The position of the benefit recipient becomes stronger if the new benefits triangle is retained and if there are contracts between service providers and benefit recipients.
  4. Information and support for budget recipients: A personal budget can contribute towards better quality of life and increased participation. A prerequisite for this is the availability of low-threshold and independent advisory services. Otherwise, persons with intellectual disability or mental health disorders or persons who live in institutions will be excluded.
  5. Costs: Better cost efficiency is expected, with a better balance between costs and health and well-being.

Cooperations

Financial support

Publications