While the open house vision is increasingly accepted in principle, many services are slow in adapting to the new philosophy. Evaluation paradigms and approaches have been evolving. There is a strong trend in the evaluation field towards participatory and empowerment evaluation, with greater involvement of consumers in the process. There is insufficient information about the full costs of disability, and the fiscal relationships among disability programs are unclear. The fact that benefits from program measures and expenditures may accrue in different cost centres is one of the biggest obstacles to systemic change.
Greater consensus is needed on appropriate outcome measures for evaluating disability policy.
Without agreement on at least the general goals of policies, it can be difficult or impossible to focus evaluation efforts. Consequently, evaluation findings may not be considered meaningful or acceptable. There is particular potential for using the concept of quality of life as a primary outcome indicator, all the while considering the degree of cost-effectiveness.