Doubts over personal health budget model

PERSONAL HEALTH budgets, a key element of Fine Gael health policy borrowed from the Dutch health system, may do more harm than good, according to research published today.

Under a system of personal health budgets, people who are disabled or chronically ill are given money to pay directly for services to meet their needs. However, the system, which has been in use in the Netherlands since 1997, has seen annual growth in spending of some 23 per cent in recent years.

An analysis of the Dutch experience, published online in the British Medical Journal this morning, warns of the “unintended” consequences of personal health budgets. Martin McKee, professor of European public health at the London School of Hygiene and Tropical Medicine, and colleagues from the Netherlands, say that “unless the lessons of the Dutch experience are learnt, the unintended and negative consequences will outnumber the positive, empowering role of personal budgets”.

They warn of credible reports of fraud and concerns about the growth of private agencies that broker arrangements between clients and providers. The authors question whether personal health budgets might accentuate health inequalities and allow the money to be spent on unproven, alternative health treatments.

Under the Dutch system, people can choose to have a personal health budget or to receive care in a traditional way from standard providers. However, spending on those who have personal budgets has increased at a much faster rate than for people who receive standard care. This is largely explained by “increased uptake by children and adolescents with learning disabilities, autistic spectrum diagnoses, and intellectual disabilities”, the authors note.

The Fine Gael health manifesto, published in advance of last year’s general election states: “By the end of our first term in government, Fine Gael will give people with disabilities the option of ‘personal care budgets’ so that they can choose the services that meet their individual needs. Personal budgets introduce greater transparency in funding and improved targeting of resources.”

Because of concerns about rising costs and fair access, the eligibility criteria for personal budgets in the Netherlands are set to change substantially. By 2014, only people who would otherwise have to move to a nursing or residential home will be able to keep their budget or apply for one to enable them to continue living at home.