Innovation and risk in care policy. A comparative analysis of cash for care schemes for people with disabilities in the Netherlands, England and Germany.

In this paper we want to empirically identify the extent to which risks occur with the introduction and implementation of cash for care systems for people with disabilities, and which risks and for whom. We are particularly... [ view full abstract ]

In this paper we want to empirically identify the extent to which risks occur with the introduction and implementation of cash for care systems for people with disabilities, and which risks and for whom. We are particularly interested in the question whether similar innovative policies in dissimilar politico-administrative systems lead to (dis)similar risks related to the introduction of innovative policies. Based on a classification of risks we identify risks for clients/beneficiaries and for government. To answer our research question we analysed policy documents and interviewed key stakeholders in the systems. The major risks for clients are (a) that the systems only enable those clients who are able to express their own desires and those with a strong network, (b) individuals become more dependent on local implementation and frontline discretion, (c) bureaucracy and complexity hampers real choice, control and flexibility, (d) clients become more vulnerable to budget cuts. For governments, the main risks are (a) losing organizational legitimacy and reputation, (b) quality and control issues, (c) and the financial risk.