Personal healthcare budgets: what can England learn from the Netherlands?BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e1383 (Published 06 March 2012) Cite this as: BMJ 2012;344:e1383
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It is critical to define the function of personal health budgets in the evolving NHS (1). The debate thus far has assumed that patients will use their budget to choose from an existing set of services to meet their needs, but that the system itself will not be used as a lever to drive up quality through patient choice. However, Andrew Lansley is quoted on the Department of Health website as saying: “Personal health budgets clearly fit with the future direction of a modern NHS - an NHS which focuses on quality and gives patients more control and choice” (2). My concern is that the government sees personal health budgets as a stepping stone in the path to create a market-based system in which patients hold purchasing power - consumers with the power to choose where to spend their money.
Aside from the serious issues of patient inequality that this would provoke, experience of the introduction of medical savings accounts in Singapore suggests that such a strategy is ineffective at reducing costs and leads to hospitals simply competing on superficial and visible indicators of quality (3,4): it is easy to envisage a situation where private providers will seek to attract patients with glamorous healthcare products which are neither evidence-based nor cost-effective, with the NHS ultimately being left to pay the price. The government knows that offering people a 'personal budget' and 'choice' is a safe way to gain popularity, but if the intention is indeed to move towards a healthcare market where personal budgets are used as a means to improve quality, this should be stated explicitly to allow debate.
(1)Ginneken E, Groenewegen PP, McKee M. Personal healthcare budgets: what can England learn from the Netherlands? BMJ 2012;344:e1383
(2)http://www.personalhealthbudgets.dh.gov.uk/News/item/?cid=8349 ‘Andrew Lansley announces personal health budgets to be rolled out to people eligible for NHS Continuing Healthcare from 2014’ (accessed 5th April 2012)
(3)Hsiao WC. Medical savings accounts: lessons from Singapore. Health Aff (Millwood) 1995;14(2):260–6
(4)Ali AM. Are MSAs effective for cost-containment? British Journal of Healthcare Management 2009;15(10):476-483
Competing interests: No competing interests