In light of the current investigations by England’s Department of Health into personal healthcare budgets, which would provide patients with more control over their care, bmj.com experts warn that England should learn from other countries first, to ensure that similar mistakes in terms of personal healthcare budgets are avoided.
One method would be to hand control to disabled and chronically ill people over their own budget so they can pay directly for the services they require. Whilst 64 primary care trusts are currently involved in a pilot project, the Netherlands, who has a similar system, is currently preparing to place limitations on the system due to various problems, one of them being a declaration of the Dutch Ministry of Health that the system has become unsustainable.
Patients in the Netherlands have held a personal budget to purchase their care since 1997. However, between 2002 and 2010, the number of personal budget holders has risen to ten times the amount, with spending increasing by an average of 23% per year. In addition, convincing reports of fraud have raised concerns about the growing numbers of private agencies that act as brokers between clients and providers.
Professor Martin McKee from the London School of Hygiene and Tropical Medicine and his team from the Netherlands state:
“Unless the lessons of the Dutch experience are learnt, the unintended and negative consequences will outnumber the positive, empowering role of personal budgets.”
Even though personal health budgets seem to be welcomed by some, questions in terms of how the budgets will be set, what happens if the budget is spent and whether there is a risk of those who are vulnerable being exploited by unscrupulous providers or brokers still remain unanswered.
According to a preliminary report, instead of using the budget as intended to buy conventional treatments, patients may also spend it on alternative therapies, such as aromatherapy, reflexology of reiki that are not scientifically proven to be effective. This raises the question whether it is justified to spend the limited resources available on ineffective treatments, especially during times when the economy is low.
As a result of this, the Netherlands will be introducing significant changes in terms of who will be eligible for a personal budget. For instance, only allowing those people to keep their personal budget, by 2014, who move to a nursing or residential home or apply for one to allow them to continue living at home. The Netherlands will also introduce new strategies to fight fraud and place restrictions on brokers.
In a concluding statement the bmj experts warn:
“If the English proposals are to succeed they will have to establish clear rules and regulations, along with adequate support to enable people to administer their budgets independently, without specialized private agencies. The UK government must also recognize that personal budgets can create new demand.”
As a consequence, they add that eligibility rules and entitlements “should be evaluated carefully to avoid creating false expectations and potentially disappointing many people.”
Written by Petra Rattue