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

Abstract

In cash-for-care schemes, care users are granted a budget or voucher to purchase care services, assuming this will enable care users to become engaged and empowered customers, leading to more person-centered care. However, opponents argue that cash-for-care schemes transfer the responsibility of the care organization from the Government to the care user, thus reducing care users’ feelings of empowerment. The tension between these opposite discourses feeds the assumption that other factors affect care users’ experience of empowerment. Therefore, this review explores which antecedents influence the level of empowerment as experienced by care users in cash-for-care schemes. A systematic review on empowerment and person-centered care in cash-for-care schemes was conducted, searching seven databases until March 10, 2020. Included articles needed to be peer-reviewed, written in English or French, and containing empirical evidence of the experience of empowerment of budget holders. The initial search identified 8261 records of which 75 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, the financial climate, the regulatory framework, and access to support and information. The identified personal characteristics refer to the financial, social, and personal resources of a care user. This review confirms that multiple factors affect care users’ experience of empowerment. However, active cooperation and communication between care user and care provider are essential if policy makers want to increase care users’ experience of empowerment.