The effects of direct payments on care outcomes among older people in England

Objectives: Direct Payments have been rolled out in England to empower individuals with choice and control over service arrangements. However, evidence on the effectiveness of Direct Payments for older people is limited. This study investigates the impact of Direct Payments on care outcomes and explores how policy impacts vary among older people.

Methods: This study used data from the English Longitudinal Study of Ageing (ELSA, 2012–2023) on adults aged 65 and older who used Direct Payments or managed care (n = 568). We applied propensity score matching methods to estimate the impact of Direct Payments on unmet needs, depressive symptoms, and quality of life.

Results: Direct Payments reduced unmet needs and showed non-significant effects on depressive symptoms and quality of life. Older people with a moderate to high likelihood of using Direct Payments benefited significantly in addressing unmet needs.

Discussion: The findings suggest that Direct Payments effectively improve care outcomes for older people, and individuals from more advantaged backgrounds are more likely to benefit. Policymakers and practitioners should support disadvantaged groups and mitigate disparities in care outcomes.