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

Zhang, Jinbao, Chen, Yu-Chih, Shi, Cheng, Wang, Julia Shu-Huah (2023) Developing an Operationalized Framework for Comparing Consumer-Directed Care for Older Adults: Evidence from Expert Survey and Cross-National Comparison. Journal of Aging & Social Policy, . pp. 1-21. ISSN 0895-9420. E-ISSN 1545-0821. (doi:10.1080/08959420.2023.2297594) (KAR id:104506)


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.

Item Type: Article
DOI/Identification number: 10.1080/08959420.2023.2297594
Additional information: For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Uncontrolled keywords: participant-directed care, self-direction, international comparison, Cash-for-care, long-term care insurance
Subjects: H Social Sciences > HV Social pathology. Social and public welfare > HV59 Institutional care/home care
Divisions: Divisions > Division for the Study of Law, Society and Social Justice > School of Social Policy, Sociology and Social Research > Personal Social Services Research Unit
Funders: National Institute for Health Research (
Depositing User: Jinbao Zhang
Date Deposited: 05 Jan 2024 12:18 UTC
Last Modified: 04 Mar 2024 15:15 UTC
Resource URI: (The current URI for this page, for reference purposes)

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