Governing Personal Assistance in Three East Asian Countries: Policy Choices and the Experiences of Disabled People

ABSTRACT Personal assistance (PA) is central to the independent living movement, yet comparative research on its governance in East Asia remains limited. This study brings a disability rights perspective on autonomy into dialogue with Gilbert & Terrell's (2012) four policy dimensions—allocation, provision, delivery, and finance—to analyse PA systems in Japan, Korea, and Taiwan. Drawing on documentary research and 30 interviews with PA users, the study finds that although access is available across impairment types, eligibility remains conditional, shaped by functional assessments, means‐testing, and bureaucratic filters. All three countries deliver PA through non‐cash, provider‐managed models without direct payments, limiting autonomy and user control. Income‐based co‐payments and fragmented financing reinforce inequalities. While participants valued PA for supporting independence, they reported insufficient hours, administrative restrictions, and gaps in support for employment and community life. Taiwan's underfunded and fragmented system particularly undermines autonomy, while Japan and Korea illustrate contrasting tensions between decentralisation, centralisation, and fiscal constraint. The findings show how East Asian PA systems institutionalise constrained autonomy, contributing to global debates on the governance of independent living rights.