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

Background In cash-for-care schemes, care users are granted a budget or given a voucher to purchase care services, under the assumption that this will enable them to become engaged and empowered customers, leading to more person-centered care. However, opponents of such schemes argue that the responsibility of organizing care is thereby shifted from governments to care users, thus reducing care users’ experience of empowerment. The tension between these opposing discourses supposes that other factors affect care users’ experience of empowerment. Objective This systematic review explores the experiences of empowerment and person-centered care of budget holders in cash-for-care schemes and the antecedents that can affect this experience. Method We screened seven databases up to October 10, 2022. To be included, articles needed to be peer-reviewed, written in English or French, and contain empirical evidence of the experience of empowerment of budget holders in the form of qualitative or quantitative data. Results The initial search identified 10,966 records of which 90 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, supportive financial climate, flexible regulatory framework, and access to support and information. The identified personal characteristics refer to the financial, social, and personal resources of the care user. Conclusion This review confirms that multiple factors can affect care users’ experience of empowerment. However, active cooperation and communication between care user and care provider are essential if policy makers wish to increase care users’ experience of empowerment.