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Health Policy. 2012 Jun;106(1):76-87. doi: 10.1016/j.healthpol.2012.03.003. Epub 2012 Mar 29.

(De)centralization of social support in six Western European countries.

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  • 1NIVEL (Netherlands Institute of Health Services Research), PO Box 1568, 3500 BN Utrecht, The Netherlands.



Participation of disabled or chronically ill persons into the society may require support in the sense of human or technical aid. In this study we look into the decision making power of governments and the way citizens are involved in these processes. Decision making power can be political, financial and administrative and may be organized at national, regional or local level.


This is a cross-sectional descriptive study of the decision making power in Belgium, France, Germany, the Netherlands, Sweden and the United Kingdom in 2010. We focused on acts and regulations for human and technical aids and for making the environment accessible.


Several acts and regulations were identified in relation to social support. In the Netherlands and Sweden social support was mainly organized in one act, whereas in the other countries social support was part of several acts or regulations. Citizen's voice appeared to be represented in boards or advisory committees. Descriptions of entitlements varied from explicitly formulated to globally described.


The level of decision making power varies between the countries en between the types of decision making power. Citizens' participation is mainly represented through patient associations. Countries with strongly decentralized decision making make use of framework legislation at national level to set general targets or aims.

Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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