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Warning from the Netherland to England on personal health budgets

Netherlands revamps criteria to crack down on fraud and rising costs

Ingrid Torjesen

Wednesday, 07 March 2012

The Netherlands is toughening up the eligibility criteria for its system of patients holding personal budgets to purchase care following evidence that it has been associated with fraud, increased costs and become unsustainable, according to a report on bmj.com.

This is a stark warning to the NHS in England which is exploring the possibilities of giving patients personal health budgets and more control over their care. Pilot projects are underway in 64 primary care trusts.

Patients in the Netherlands have been able to hold a personal budget to purchase care since 1997. But between 2002 and 2010, the number of personal budget holders increased tenfold, while spending increased on average by 23% a year. There have also been credible reports of fraud and concerns about the growth of private agencies that broker arrangements between clients and providers. The Dutch Ministry of Health is now arguing that it has become unsustainable.

Professor Martin McKee from the London School of Hygiene and Tropical Medicine said: “Unless the lessons of the Dutch experience are learnt, the unintended and negative consequences will outnumber the positive, empowering role of personal budgets.” He said many questions remained over how the system would work, including how  budgets would be set, what would happen when budgets were spent, and was there a risk that vulnerable individuals might be exploited by unscrupulous providers or brokering agencies.

A preliminary report on the Dutch experience also showed that patients might spend their budget not only on conventional treatments, but also on alternative ones, some of which, like Reiki, reflexology, and aromatherapy, are not supported by scientific evidence.

The eligibility criteria for personal budgets in the Netherlands are now to be changed 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. Measures to combat fraud and restrict the use of brokers will also be introduced.

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