The glass half full? Proportional rationing and well-being in disability care.

BACKGROUND

Personal budget schemes for people with disabilities have expanded globally, yet demand often exceeds funding, resulting in extensive waiting lists. One policy response is proportional rationing: providing partial personal budgets rather than fully funding fewer individuals. This study examines whether a partial budget - set at 50% of assessed entitlements - meaningfully improve well-being for people with disabilities awaiting full support.

METHODS

We study a 2022 policy experiment in Flanders, Belgium, in which individuals on waiting lists were allocated a partial budget based on application date. Using a regression discontinuity design linking survey and administrative data (n = 316), we estimate the eligibility-induced effect of partial budget receipt for individuals near the cutoff. Outcomes include perceived unmet care needs, care satisfaction, life satisfaction, and quality of life.

RESULTS

At the cutoff, the partial budget reduced perceived unmet care needs and improved care satisfaction. Effects on life satisfaction and quality of life were more modest. Exploratory heterogeneity analyses revealed that members of user organizations experienced attenuated gains, possibly reflecting higher expectations, and that respondents with mixed payment modes showed limited benefits, a pattern consistent with care needs that cannot be proportionally divided.

CONCLUSIONS

A partial budget can mitigate some harms of prolonged waiting, but its effectiveness depends on whether care needs can be proportionally divided and on recipients' expectations. When support falls below meaningful thresholds, proportional allocation may distribute resources without generating substantial improvements. Proportional rationing is not a neutral policy instrument; designing rationing mechanisms requires attention to need structure and how recipients evaluate partial provision.