The service delivery system for assistive technology in Sweden: Current situation and trends

Abstract

This paper gives a brief description of the service delivery system for assistive technology used in daily life (AT) in Sweden, and includes discussion on present changes and trends. In Sweden the responsibility for provision of AT is shared between counties/regions and municipalities. The greater part of the cost for prescribed AT is paid by taxes. Each county/region and municipality decides on its fees and assortment of AT; there are no national guidelines or coordination. The prescription process is part of the rehabilitation process, where assessment of needs precedes prescription. In 2007 the Swedish government commissioned a programme in which trials with a voucher system were conducted in three counties and eight municipalities. The trials were evaluated and interviewed users expressed that the voucher system increased their participation in the process and that they experienced more satisfaction when they had purchased the AT on their own. The voucher system has been criticized by some users; notably by the main user organisation for persons with hearing impairments. During the past ten years, the range of AT that can be prescribed has been reduced and users have to buy some types of AT as consumer products on the private market.

“You have to argue the right way”: user involvement in the service delivery process for assistive activity technology

“…In turn, people already participating in activities enjoy greater opportunities to become and stay active, whereas less active ones become increasingly excluded. Mounting differences in access to AT between informed and non-informed users have also been reported among AT users in Sweden [20]. Users as equal partners, seems vital for user involvement in the service delivery process for assistive activity technology.…”

“…Testing is thus not only important to forecasting the outcomes of assistive activity technology but also for its effective implementation in terms of delivery, fitting, and training [30]. After testing, follow-up becomes another vital aspect of any successful service delivery process [5,14,20,21]. Social constructionism stresses the importance of historical and structural aspects in how social phenomena are understood [34,35].…”

“…By not maintaining such protocols, the service delivery process risks the abandonment of assistive activity technology by users, which is a well-known phenomenon for a wide range of AT [21,50]. As revealed by earlier studies [20], gaps in follow-up services also adversely affect the use and reuse of technology, and distribution of inappropriate technology can cause environmental problems. Whether the outcome of a given case is successful seems to coincide with both professionals' and the user's expertise with the service delivery system and assistive activity technology.…”

“…However, due to unsystematic information and high costs, people with disabilities can also face difficulties in accessing AT tailored to meet their individual needs [17][18][19]. On top of that, researchers in Sweden have shown that having users take increased responsibility for their AT has revealed considerable differences among them in terms of their user knowledge, interests, and access to the technology [20]. Given the range of users, though ones who are informed and can choose appropriate AT for themselves positively affect the outcomes of the service delivery process [5,13,20,21].…”

“…On top of that, researchers in Sweden have shown that having users take increased responsibility for their AT has revealed considerable differences among them in terms of their user knowledge, interests, and access to the technology [20]. Given the range of users, though ones who are informed and can choose appropriate AT for themselves positively affect the outcomes of the service delivery process [5,13,20,21]. A strongly consumer-oriented service delivery system could also threaten the opportunities of less informed users to participate in play, sport, and leisure-time physical activities.…”