Formulating individual capabilities considering differences in utilization ability: under the social preference of independence to social service utilisation

Kobayashi, Hideyuki; Gotoh, Reiko (2016). 'Formulating individual capabilities considering differences in utilization ability: under the social preference of independence to social service utilisation' Paper presented at the annual conference of the HDCA, Tokyo 2016.


abstract
Background: The value an individual person finds in his or her daily life ranges broader and diversely, however health or social service provided when having diseases or disabilities cannot reflect all aspects of the individual’s life. Service providers or social service authorities often focus on aspects relating to social budgets and costs, which could cause a possibility that individuals are restricted within narrow opportunity sets to utilise social service according to the nature of aspect. Here capability approach can be applied to evaluate individuals’ well-being based on their diverse lifestyles in which their sense of value is reflected. However the process of operational formulation of capability approach is not well known both in theoretical and empirical studies. 
Aim: Firstly for thetheoretical development, to formulate the structure of individual capabilities considering individual differences of goods and utilisation ability, by capturing process that an individual utilise goods to achieve well-being based on characteristic theory and human capital theory. Then, to verify the present model through empirical analysis on individual achievement of functionings in independence and social service utilisation in home-care settings.
Theoretical formulation: To developtheoretical formulation, capability consisted of two functionings “having living arts” (l) and “accessing social services” (s) are considered by changing the distribution of goods and compensation by social service provision between the two functionings. Individuals distribute their goods z between the two functionings. The distributed goods is transformed by their utilisation ability (fL, fS) to functionings l and s, respectively. The set of vectors X(l, s) represents the individual’s capability set C. Suppose the goods of an individual who is in health without social service provision (zH) is smaller than that of another individual who has diseases or disabilities compensated by social service provision (zC), and that the individuals choose ZH, ZC in the space of goods to achieve XH, XC on capability set CH, CC, respectively. When having diseases or disabilities, it is more difficult to achieve “having living arts” with distributing a certain goods than when being in health, so there is a difference in utilisation ability to “having living arts” (fL,H> fL,C). From those differences in goods and utilisation ability between being in health without social compensation and having diseases or disabilities with social compensation, the capability set differs. That of being in health CH is biased on “having living arts”, whilst that of having disease or disabilities CC is biased on “accessing social services”. 
Empirical analysis: The two functionings were captured by patients’ experiences using questionnaire items. The verge of capability set was captured by the linear approximated lines of achievement points of a patient group on the functionings plane. Patients are classified into two groups by activity restriction using EuroQual questionnaire EQ-5D. Less-restricted group is regarded as being more in health with little social service provision, whilst more-restricted group is as having more diseases or disabilities with much social service provision. The inquiry was carried out in 2011 for home-care clients in Japan. Responses of 199 clients were analysed and capability set of each patient group was constructed in the plane of “having living arts” and “accessing social services. The capability set of more-restricted group was biased on “accessing social services”, whilst the mean of the group was deviated towards “having living arts”. On the other hand, that of less-restricted group was biased on “having living arts”, whilst the mean of the group was deviated towards “accessing social services”. 
Discussions: The present theoretical model almost verified with empirical analysis above. Thosewho are more-restricted in activities have more goods with compensated by social service provision. Although the steeper inclination of the regression line for them suggests that they can achieve higher “accessing social services”, the observed points located deviated towards “having living arts.” There is a possibility that “having living arts” is socially preferred to “accessing social services” and individuals who are compensated by social services are forced to choose their achievement points deviated to “having living arts.” On the other hand, individuals, who have less restriction in activity and are not provided social services so much, are free from such a social preference and can choose achievement points deviated towards “accessing social services”. 
Key words: capability formulation, structure of capabilities, individual differences, health service evaluation, social preference

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