Seund J zyxwvutsrqponmlk Soc zyxwvutsrqponmlk Welfure 1994: 3: zyxwvutsrqp 6145 Printed in Denmark zyxwvutsrqponm . All rights reserved zyxwvutsrqponm It has been frequently discussed whether the Swedish disability service system is efficient and whether it meets the demands of equity. The costs of the system for support and service were recently estimated to be USD 11 billion. This article describes the welfare situation for disabled people compared with the general population in Sweden. The Swedish disability service system has managed to provide disabled people with a disposable income over the subsistence minimum in Sweden, but also in the same range as for the general population. In other welfare parameters, disabled people appear to have great welfare losses compared with the general population. Evaluations of handicap technologies (such as service and sup- port) aiming to reduce or compensate for these welfare losses have to meet the requirements of equity and efficiency of the Swedish disability Copyright zyxw 0 Munksguard 1994 Welfare consequences of the Swedish disability service system The Swedish system for support and services to people with disabilities and handicaps aims to reduce or compensate for welfare losses due to disability. It has been frequently discussed, for example, by the Swedish 1989 Disability Commission (1992) whether the Swedish disability service system is efficient and whether it meets the demands of equity. The costs of the Swedish disability service system were estimated to be about USD 11 billion (5% of the gross national product in Sweden) in 1989 (Jonsson, 1991). Social insurance transfer payments are 50% of the total costs; the other half consists of real resource utiliza- tion. There is still little knowledge about the relation- ship between resources spent and welfare gained, and also whether the Swedish disability service system provides an optimal welfare situation. The purpose of this article is to examine the wel- fare situation of disabled people and to identify un- met need for service and support. The purpose is also to discuss how evaluation studies of support and ser- vice for disabled people could be performed. zyxwvu Methods and data The unmet need for support and service is con- sidered as the difference in welfare between the gen- eral population and disabled people. Measures of welfare used here are perceived health, financial re- sources, need of assistance, social relations and qual- ity of life (Rosser & Watts, 1972; Gudex & Kind, 1988). All economic data are expressed in USD (SEK 5.56 in 1991; currently about SEK 8.3). The zyxwv IC*”YIUhllhN zyxwvu ,OURNIL OP SOCIAL WELFARE ISSN 0907-2055 U. Hass, D. Jonsson Center for Medical Technology Assessment, Linkoping University, Sweden Key words: disability; welfare; equity; efficiency Ursula Hass, Center for Medical Technology Assessment, Linkoping University, S-581 83 Linkoping, Sweden Accepted for publication October 19, 1993 data were obtained from a national study of living conditions for the handicapped and disabled (Stat- istics Sweden, 1992), and from case studies of the health status, quality of life and economic situation for people with functional impairments (Hass, 1991). A self-completed questionnaire by Gudex & Kind (1988) was used to generate quality of life, as defined in Rosser & Watt’s (1972) classification of illness states. In the national study of living conditions in 1988-1989, 13,304 interviews were made with people between the ages of 16 and 85. Disability or disorder groups are: cardiovascular disease, pulmonary dis- ease, asthma, allergies, diabetes, psoriasis, mobility disability, poor vision, impaired hearing, sharply re- duced working capacity and dependent on assist- ance. Each person can belong to more than one group. The case studies were performed during 1990- 1991. In the case studies, one aim was also to de- scribe the situation for people belonging to a dis- abled subgroup that were feared to have a worse wel- fare situation than other disabled people. The selec- tion of the case studies is based on discussions with representatives from the national associations for disabled people concerning the need for support in everyday life, from the municipality and from rela- tives and on type of disability or disorder. The dis- abled people in the case studies were between the ages of 5 and 63 years and represented people with poor vision, muscle weakness, speech impairment, impaired hearing, mentally retardation, cardiovascu- lar disease, asthma and allergies. The household size 61