To what extent are clients in the Exceptional Medical Expenses Act (AWBZ) able to make conscious choices (or have them chosen by relatives and representatives) between providers? Commissioned by the Ministry of Economic Affairs we have found the answer to this question on the basis of literature research and interviews. In addition, the report provides insight into how choice in long term care in other countries is regulated, in the United Kingdom, Canada, New Zealand, Belgium, Denmark, Germany, France and Ireland.

The answer to the research question is as follows. What is necessary to create choice is selection ability, opportunity to choose and being motivated to choose. Regarding ability, a significant proportion (about 70%) of the users of AWBZ-funded care has the basic ability to choose and those who cannot choose often have a carer who does possess these basic skills.

The opportunity to choose is limited to very limited due to the shortage in supply (only in home care the opportunity is less limited). In addition, limited time due to the crisis-like nature, especially in psychogeriatric and rehabilitation care, energy loss and absorption problems that are at issue for people with psychiatric disorders constraint the opportunity to choose for certain groups.

Motivation to independently distinguish good and bad care is limited due to the fact that quality is difficult to estimate in advance, the fact that correcting choices is very costly (with home care this slightly less) and due to current concerns about the existence of the excessive number of health care institutions that deliver care below the basic quality. Apart from all this the fact remains that people like to choose care that is nearby, particularly for hospital health care and day care.

To give people more choice, it is best to equip them with clear care arrangements, independent information, voting rights and a choice supporter, if necessary. And at the same time ensure that the basic quality is guaranteed by the inspection. Because even though a large part of the client organizations is against obligated choice, everyone benefits from more client-oriented care.