Analysis of cost and quality indicators of day activity service programmes in Sweden

Several countries provide day activity programmes for people with intellectual disabilities. Little is known about the quality of these programmes or about their effectiveness in providing vocational training. In this study, we analysed the distribution across Swedish municipalities of the cost per user and how this is related to five structure quality and one outcome quality variables. We observed that the expenditure per attendee varies considerably between different municipalities. Statistical analysis was used to study to what extent expenditure per user correlates with supply-side factors, (political) demand-side factors and quality indicators. This indicated that the variation of expenditure is not explained by supply-side factors only. The local tax base and other local economic and/or political circumstances are statistically significant covariates, in spite of the entitlement legislation that gives eligible persons right to services of equal quality independent of such location-specific factors. We also found that municipalities that conduct regular user surveys find reasons to, on average, spend more per user. Finally, we found that the probability for transitions to employment at a regular workplace is higher in municipalities where as an annual routine, a review is made of whether each participant can be offered an internship or work.