Intended for healthcare professionals


Personal healthcare budgets: what can England learn from the Netherlands?

BMJ 2012; 344 doi: (Published 06 March 2012) Cite this as: BMJ 2012;344:e1383
  1. Ewout van Ginneken, Dutch Commonwealth Fund Harkness fellow in healthcare policy and practice1,
  2. Peter P Groenewegen, director2,
  3. Martin McKee, professor of European public health3
  1. 1Department of Health Policy and Management, Harvard School of Public Health, Boston, MA, USA
  2. 2Netherlands Institute for Health Services Research, Utrecht, Netherlands
  3. 3London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
  1. Correspondence to: M McKee martin.mckee{at}
  • Accepted 18 January 2012

The English Department of Health proposes to allow people who need continuing care to purchase the services and equipment they think are most appropriate through personal budgets. Yet the Netherlands, which has had a similar system, is in the process of restricting it in the light of problems that have arisen. Ewout van Ginneken, Peter P Groenewegen, and Martin McKee examine what has gone wrong and how England could avoid the same mistakes

The English Department of Health wants to give patients more control over the care they receive. One way they propose to do this is through personal healthcare budgets for people eligible for NHS continuing care. The health secretary, Andrew Lansley, says the “budgets will give them more control over how their needs are met, allowing them to choose support and services that suit them and their families.”1 It builds on the English experience with personal budgets for social care, which has suggested potential benefits, especially in empowering budget holders.2

English experience with health budgets has so far been limited.1 Pilot projects are being undertaken in 64 primary care trusts, of which 20 are included in a Department of Health funded evaluation. A preliminary report from this evaluation, which concedes that the experiences reviewed may be atypical and which was undertaken before most of those interviewed had begun to receive services, identified the things that patients with long term conditions might wish to spend their budgets on, if they had the freedom to do so.3 They included not only conventional treatments but also alternative ones, some of which, such as reiki, reflexology, and aromatherapy, are not supported by scientific evidence. They also included services that might increase a sense of wellbeing, such as massage and manicures, and technology, such as laptops and …

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