Influence of municipal policy and individual characteristics on the use of informal and formal domestic help in the Netherlands.

Background: The responsibility for care and social support in the Netherlands has been decentralized to the municipalities, on the assumption that they are able to organise care and social support more effectively and efficiently. Municipalities are responsible for offering citizens the social support they need. They have policy discretion to decide how and to what extent they encourage and support the use of informal help. This article explored whether the local policy focus on informal or formal help influences the actual take-up of domestic help. Methods: Data on 567 physically disabled people who use informal or formal help in the household were linked to local policy data in 167 municipalities. We performed multilevel multinomial regression analyses. Since we expected that local policy will have more influence on people with slight or moderate disabilities, cohabitees and people aged under 75, cross-level interaction terms were included between characteristics of local policy and of individuals. Results: The findings reveal differences between municipalities in their policy on support and differences in the use of formal or informal support between municipalities. Conclusions: We found no relationship between local emphasis on informal help and the use of informal help. Possible explanations: some people have a small social network, people using informal help did not apply for municipality support or even do not know the possibility exists. (aut. ref.