The role of choice in Assistive Technology provision in Europe

Abstract

Objective: A client-centred approach has not been fully realised in Assistive Technology (AT) provision and, in response, there have been moves toward enhancing choice through the use of individual budgets. Choice is advocated in healthcare to enhance quality and strengthen individual rights, but in a market environment can leave customers overwhelmed rather than empowered if not supported by independent advice and information. Can client choice be extended to those who seek and can benefit from choice have access, while providing practitioner support for those who want or need it?Main Content: This article draws on literature from healthcare governance and the ‘logic of choice’ as described by the scholar Annemarie Mol, and applies it to the context of AT provision in Europe. The value of individual choice is emphasised in market-oriented healthcare reforms, and is an approach to healthcare that counters paternalism but risks neglect, contrasting with the ‘logic of care’ where decisions and responsibilities are shared.Results: Practitioners may have doubts about the risks and quality of outcomes when clients choose AT without close supervision. Clients also have reason to be sceptical about the reality of choice, given the requirement of an initial needs assessment to determine eligibility for some of the choice initiatives. This could be perceived as gate-keeping or paternalism from practitioners, but may alternatively be regarded as a necessary form of support and quality assurance to prevent clients from making choices they are not prepared for and may regret.Conclusion: The expansion of choice in European AT provision can be seen as part of the shift of healthcare to a market competition mode of governance. Choices remain regulated however, in an effort to balance and preserve values including autonomy, equal access and quality of care. AT provision without access for clients to unbiased and ongoing support risks reduced quality of outcomes and satisfaction, just as practitioner prescription that does not involve and engage clients and consider their individual situation does. While individual choice in AT provision may result in better selection and greater satisfaction for some clients, it should be regarded as an addition or optional alternative to practitioner-guided provision.