Developing an Operationalized Framework for Comparing Consumer-Directed Care for Older Adults : Evidence from Expert Survey and Cross-National Comparison

Jinbao ZHANG, Yu-Chih CHEN, Cheng SHI, Julia Shu-Huah WANG*

*Corresponding author for this work

Research output: Journal PublicationsJournal Article (refereed)peer-review

Abstract

Consumer-directed care (CDC) programs for older people aim to optimize health outcomes by offering clients control and flexibility regarding service arrangements. However, policy design features may differ due to heterogenous sociostructural systems. By operationalizing a framework with three dimensions of CDC, i.e. control and direct services, variety of service options, and information and support, we analyzed how countries vary in their policy designs to achieve consumer direction. Using an expert survey (n = 20) and cross-national document analysis, we analyzed 12 CDC programs from seven selected countries: the United States, the United Kingdom, Germany, the Netherlands, China, Australia, and Spain. Among the three dimensions, CDC programs placed more emphasis on and displayed more homogenous performance of policy designs that achieve consumer direction in the dimension of control and direct services, while less emphasis was placed on and more heterogenous performance displayed in the dimensions of variety of service options and information and support. We offer a systematically operationalized framework to investigate CDC policy designs. Findings advance our understanding of CDC policy features from a cross-national perspective. Policymakers could incorporate these findings to empower older people in their respective societies.
Original languageEnglish
Number of pages21
JournalJournal of Aging and Social Policy
Early online date27 Dec 2023
DOIs
Publication statusE-pub ahead of print - 27 Dec 2023

Bibliographical note

We thank the following persons for their participation in our expert survey: Ernest Chui, PhD, Padraic Fleming, PhD, Judith Gross, PhD, Billingsley Kaambwa, PhD, Kevin J. Mahoney, PhD, Prof. Jill Manthorpe, Pamela Nadash, PhD, and Kailu Wang, PhD. We also appreciate other anonymous experts who responded to the survey and contributed to this research project.

Publisher Copyright:
© 2023 Taylor & Francis.

Keywords

  • Cash-for-care
  • international comparison
  • long-term care insurance
  • participant-directed care
  • self-direction

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