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Do Cash-For-Care Schemes Increase Care Users’ Experience of Empowerment? A Systematic Review

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A Correction to this article was published on 11 May 2023

This article has been updated

Abstract

Background

In cash-for-care schemes, care users are granted a budget or given a voucher to purchase care services, under the assumption that this will enable them to become engaged and empowered customers, leading to more person-centered care. However, opponents of such schemes argue that the responsibility of organizing care is thereby shifted from governments to care users, thus reducing care users’ experience of empowerment. The tension between these opposing discourses supposes that other factors affect care users’ experience of empowerment.

Objective

This systematic review explores the experiences of empowerment and person-centered care of budget holders in cash-for-care schemes and the antecedents that can affect this experience.

Method

We screened seven databases up to October 10, 2022. To be included, articles needed to be peer-reviewed, written in English or French, and contain empirical evidence of the experience of empowerment of budget holders in the form of qualitative or quantitative data.

Results

The initial search identified 10,966 records of which 90 articles were retained for inclusion. The results show that several contextual and personal characteristics determine whether cash-for-care schemes increase empowerment. The identified contextual factors are establishing a culture of change, supportive financial climate, flexible regulatory framework, and access to support and information. The identified personal characteristics refer to the financial, social, and personal resources of the care user.

Conclusion

This review confirms that multiple factors can affect care users’ experience of empowerment. However, active cooperation and communication between care user and care provider are essential if policy makers wish to increase care users’ experience of empowerment.

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Data availability statement

A detailed overview of the search string per database and the coding sheet can be found in the Electronic Supplementary Material. The data used and analyzed during the current study are available from the corresponding author on reasonable request.

Change history

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Funding

This study was funded by BOF.STG.2018.0026.01.

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Authors and Affiliations

  1. Department of Public Health and Primary Care, Ghent University, Campus University Hospital Ghent, Building K3 Fourth Floor: Entrance 42, Corneel Heymanslaan 10, 9000, Ghent, Belgium

    Eva Pattyn, Sophie Vandepitte & Jeroen Trybou

  2. Department of Marketing, Innovation and Organization, Ghent University, Building Hoveniersberg, Tweekerkenstraat 2, 9000, Ghent, Belgium

    Paul Gemmel

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  1. Eva Pattyn
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Contributions

EP: Conceptualization, Methodology, Literature search, Data analysis, Writing—original draft. PG: Conceptualization, Supervision, Writing—review & editing. SV: Literature search, Writing—review & editing. JT: Conceptualization, Supervision, Writing—review & editing.

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Correspondence to Eva Pattyn.

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Eva Pattyn, Paul Gemmel, Sophie Vandepitte, and Jeroen Trybou declare that they had no support from any organization for the submitted article; no financial relationships with any organization that might have an interest in the submitted work; and no other relationships or activities that could appear to have influenced the submitted work.

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The original online version of this article was revised to remove the irrelevant legends from Tables 3 to 6.

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Pattyn, E., Gemmel, P., Vandepitte, S. et al. Do Cash-For-Care Schemes Increase Care Users’ Experience of Empowerment? A Systematic Review. Patient 16, 317–341 (2023). https://doi.org/10.1007/s40271-023-00624-z

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