Biomedical Engineering Reference
In-Depth Information
TABLe I.1
Service Delivery S
ystem and Model
Country
Service Delivery System
a
Service Delivery Model
b
Australia
Private system
Consumer
c
Austria
Public system and private system for
self-employed
Social and medical
Denmark
Public system (health and municipalities)
Social
Finland
Public system (health)
Medical
France
Public system
Medical, social, and consumer
Germany
Private system and partially public system
Medical and social
Greece
Public and private system
Medical and consumer
Italy
Public system (health)
Medical and social
Netherlands
Private and public system
Medical and social
Norway
Public system (municipality)
Medical
Spain
Public system (health and social by regions)
Social, medical, and consumer
Sweden
Public system (health and county councils
and municipalities)
Medical
United Kingdom Private and public system (health and social) Medical, social, and consumer
United States Private system Consumer
In almost all cases, the AT for schools in the private system is managed with a public service delivery
system.
a
Survey performed between 2010 (Estreen 2010) and 2011 by the Leonarda Vaccari Institute in Rome,
Italy.
b
Stack et al. (2009).
c
Free market model in which there is no intermediary between the patient/consumer and his or her
solution (Stack et al. 2009).
In general, we can observe that in European countries, a public health system is more
diffused where the person with a disability is considered a patient/user. Inside of these
systems, the person who effects the matching does not sell AT but acts as an intermediary
between the patient/user and the AT societies by providing an assessment and support
service. In Anglo-Saxon countries (such as the United States and Australia), it may occur
that the person with a disability is considered a client inside of a private system, to which
the assessment center will sell some products. The first model ensures more neutrality
in assessing the best AT matching; the second model fosters a user-centered satisfaction
with the best matched product. In general, when there is a public system, the financing is
bound to a “prescription” effected by a specialist. Moreover, the doctor who prescribes must
carry out many duties that, in reality, should be the competence of other experts: engineers,
psychotechnologists, psychologists, psychotherapists, etc. On the other hand, in the private
service, the client may benefit from well-prepared professionals but without having the
necessary services at their disposal. Notwithstanding the diversity of service delivery
systems (public/private), recent studies prove that both systems share high AT abandonment
percentages—between 12% and 38%, with some exceptions for certain types of devices, such
as electric wheelchairs, for which the abandonment rates can be as little as 5% (Wressle and
Samuelsson 2004)—a high degree of user dissatisfaction, and a large waste of money. All of
this induces the scholars of this sector to pursue a critical elaboration of ATA process models,
which, starting from the modeling of the preexisting services, allows us to develop some
guidelines to optimize the matching process (Ripat and Booth 2005).
