Nursing home vouchers in Spain: the Valencian experience

Abstract

The main purpose of this paper is to evaluate the innovative nursing home voucher scheme that was introduced by the Valencia Autonomous Region of Spain in the early s to implement targets laid down by the national plan for the development of older people's services. The article begins with a review of the evolution of Spanish social services, and especially the nursing home sector, and then summarises the genesis, objectives and characteristics of the voucher scheme. The main part of the paper reports a performance analysis and economic evaluation of the programme. On the basis of detailed information over four years, it is concluded that nursing home vouchers have contributed to the increased supply of publicly-financed rooms, have promoted equality of access to the service, and have increased user choice. It is also shown, however, that while vouchers can lead to an increase in the quality of inputs, they increase utilisation and expenditure. In the absence of the monitoring or reporting data that would be required, it is not possible to determine whether the scheme has increased efficiency, in the sense of improving the quality of life of frail older people at reasonable and containable cost.

Explaining Low Uptake of Direct Payments in Residential Care: Findings from the Evaluation of the Direct Payments in Residential Care Trailblazers

“…This finding underlines the relevance of the second narrative that emphasises contextual factors such as differences in funding available to council-funded care home residents with a direct payment. As other examples of introducing 'cash for care' schemes for residents in care homes have illustrated, an extension of user choice is unlikely to be 'cost neutral' (Angeles Tortosa and Granell, 2002).…”

“…Although there are a few studies of 'cash for care' schemes that also extend to care-home residents, these do not examine the barriers to their implementation (Da Roit and Le Bihan, 2010). An exception is the study by Angeles Tortosa and Granell (2002) who evaluated the introduction of nursing home vouchers in the Valencia region in Spain. They found that the scheme had expanded the supply of publicly funded places in care homes and therefore improved choice of care homes for service users, yet this expansion also involved higher costs (Angeles Tortosa and Granell, 2002).…”

“…An exception is the study by Angeles Tortosa and Granell (2002) who evaluated the introduction of nursing home vouchers in the Valencia region in Spain. They found that the scheme had expanded the supply of publicly funded places in care homes and therefore improved choice of care homes for service users, yet this expansion also involved higher costs (Angeles Tortosa and Granell, 2002).…”

“…The expectation is that services will then be more personalised and better meet their needs. Such 'cash for care' schemes have been introduced in a number of countries, with many of them also providing cash payments to residents in care homes (Angeles Tortosa andGranell, 2002: Da Roit andLe Bihan, 2010). However in England, until recently, direct payments have only been available to those requiring care and support services in their own homes.…”

Quasi-markets Targets and the Evaluation of Nursing-home Funding in the Valencian Region

“…The nursing-home voucher was therefore a useful mechanism to mitigate both problems simultaneously. On the one hand, it served to reduce waiting lists in public and subsidized centers; on the other hand, it allowed many private nursing-homes to increase their occupancy, hire new workers and improve their financial viability (Tortosa and Granell, 2002).…”