Viewpoints of local decision-makers on what matters in the allocation of scarce social care resources in the Netherlands

Abstract

Social care supports individuals with functional impairments to live at home independently and participate in society for as long as possible. The demand for social care continues to rise, driven by increased longevity and demographic ageing. In the Netherlands, local decision-makers enjoy discretion to allocate the limited social care budget in view of local needs. The aim of this study is to examine their viewpoints on what matters in the allocation of scarce social care resources in the Netherlands.

We conducted a Q-methodology study among decision-makers (n = 25) employed in one of 15 municipalities in the Netherlands. Participants ranked 39 statements reflecting the underpinnings of decisions on the allocation of social care resources and explained their ranking in an interview. We used factor analysis followed by varimax rotation to identify clusters in the rankings. We then used the resulting factor arrays and interview transcripts to interpret the clusters as viewpoints. We identified four viewpoints among participants, representing views of sufficientarianism (providing support up to a basic level of needs), egalitarianism (providing equal support to as many as possible), welfarism (fostering access to high-quality social care), and communitarianism (highlighting the responsibility of informal caregivers to provide support).

The findings of this study suggest that differences in viewpoints between local decision-makers may arise from differing notions of distributive justice. While local differences may—to some extent—fall within decision-makers’ discretion, considerable differences in resource-allocations decisions on social care in the Netherlands may have consequences for horizontal equity in access.