Consumer-directed care : empowerment model of community care service voucher utilisation in Hong Kong

Abstract

Less than five years ago, the Hong Kong Special Administrative Region (HKSAR) Government initiated a new programme, based on the concept of consumer-directed care (CDC), the Pilot Scheme of Community Care Service Voucher Scheme for the Elderly (CCSV). The literature on CDC was critically reviewed, and it was found, in both the Hong Kong and international contexts, that existing research has mainly focused on programme outcomes, and few have examined process. Most notably, few have studied the process of empowerment in consumer-directed care. To address this knowledge gap, the study examines the empowerment of users involved in the CCSV Scheme. This research constructs a systematic model, analyzing how different factors, referred to and modeled as multiple forms of capital, function and interact with each other to facilitate decision-making in the use of CCSV in a comprehensive multi-level analytic approach. In this study, multiple forms of capital refer to different capabilities, resources or support required for older people to make informed choices in CCSV. This study involves extended in-depth interviews of sixty-nine (69) informants, comprised of 26 CCSV users, 27 CCSV non-users and 16 professionals. A total of 14 themes were generated, which illustrate empowerment through employment of different forms of capital in the practice of CCSV. These themes fall under the categories of the individual, social and familial, and institutional dimensions. Themes include the following: 1) the individual dimension involving “sense of self-awareness”, “education level”, “health condition” and “affordability”; 2) the social and familial dimension consists of “family support”, “collective family decision-making”, “peer influence” and “family support as compensating capital”; 3) the institutional dimension entails “professional support”, “service accessibility”, “informed choice”, “professional support as compensating capital”, “case management model” and “public education and promotion”. All these themes are integrated and interrelated in the model of empowerment and used to analyse the decision-making and use of CCSV. The analysis indicates that different forms of capital are needed by individuals (in different combinations) to make informed choices for the effective use of CCSV. Moreover, these multiple forms of capital interplay with each other and can enhance or replace deficits in some other forms of capital. This study develops a new empowerment model of community care service voucher utilisation in the Hong Kong context and offers deeper insights into why some clients successfully make choices to use the CCSV and others do not. This proposed conceptual framework offers new insights into how CCSV can empower older people to exercise their decision-making with implications for research, practice and policy. The model can be extended to other domains and used to evaluate the process of empowerment in different service delivery programmes.