Saturday, 23 January 2010

'Personal health budgets'


The government's current idea of introducing 'personal health budgets' for patients is one of the barmiest and most stupid that I have ever heard. It can initially sound like a good idea to those who are unaware of the actual implications of such a pile of steaming pig sh*t. The government will talk of 'patient choice' and the efficiency of the market in trying to convince patients and the public that this reform is in their best interests.

In reality it is an utter disaster waiting to happen, here are just a few of the grave problems I can think of at just a drop of a hat. The bureaucracy needed for such a system would be enormous. Not only would one need to work out just how much money each different patient with differing health problems would be given for a set period of time, this in itself would be an imperfect and highly expensive process. Also any mistakes in giving patients funds could lead to some being over funded, thus wasting extra cash, and some being underfunded, what on earth would happen if a patient runs out of cash to pay for their treatment?

The PCTs cannot even organise a piss up in a brewery, so something like this than would challenge the most able would be a complete disaster if handed to the fools at PCTS up and down the country. A system like this would make it impossible to efficiently ration care and services, it would be impossible for public health needs to be planned for and met as the funds would be in the hands of the patients. Another serious problem would be that most patients would have no idea which services to use with their budgets, this would undoubtedly lead to the largest rich private firms with the best advertising doing a lot of smaller providers of better quality services out of business.

Another massive problem with any market based system is one that the pro-marketeers will never admit to being a problem, the fact that for any market to work it has to assume that all the patients/consumers will make fully informed decisions all of the time, a ridiculous assumption at the best of time, this results in the inevitable rigged market in which the big and powerful will always profit. It is impossible for patients to become fully informed, even the most educated and able would struggle, and those most in need of service would be the old and frail, the chances of these patients wanting their budgets is virtually zero and their ability to be adequately informed to make the best choices for themselves is also next to zero. The system would also lead to a very inequitable system as those with budgets may well get treated very differently to those without, the 'two tier' system is a result.

As you can see 'personal health budgets' are a complete and utter disaster waiting to happen. They will be an inefficient and massively expensive way in which to burn yet more money in making a health care system more inequitable and unfair, while making it's quality of service no better, arguably much worse. The motive for this? Well it is rather obvious that this idea is just another way in which the government can introduce more privatisation by stealth.

Interestingly 'patients being given a cash entitlement to buy the services and treatments that they thought best suited their needs' is not allowed under current rules, it depends upon the enactment of the Health Bill 2009, which is due for its second Commons reading on June 8, following debate in the Lords. So it's yet another bit of legislation that is being hurried in via the back door than will allow the government to carry on privatising the NHS. I am sure the big private firms are rubbing their hands with glee, they will soon be able to advertise their services direct to patients and the money will start flowing. Whatever happened to the NHS being a public service, recent reforms have made it look more like a cash cow for various greedy private health care corporations. The planning for the health care needs of the public to be met as efficiently and productively as possible is being replaced by an inefficient bureaucratic monster that throws money to private firms at random.

12 comments:

Fuddled Medic said...

Money wasted on this would be better spent giving nurses a pay rise. And couldn't patients waste all of there budget on an ineffective treatment that they saw being advertised on the internet? Some patients may also feel guilty if they realise how much money is being spent on them for various treatments and operations and feel pressured into going for the cheaper one. Or the opposite some patients may choose the most expensive treatment (even if it is not the best), just so they feel they are getting the most for there money

Demetrius said...

You either have a "service" or you have a "business". In this case you have neither, in effect you turn the whole thing into a street market. This may suit the government but it will do nothing for the personal health of those involved.

another one of those foolish patients with a chronic illness said...

And couldn't patients waste all of there budget on an ineffective treatment that they saw being advertised on the internet?

You're totally right there. Us patients with chronic diseases, we're all completely thick. We'd definitely spend our whole budgets on homeopathy and shamanism, after all it's not like we have any interest in staying well or managing our chronic diseases.

Of course we have no wish to see one specialist over another as they're all the same really aren't they? And we pay no attention to the latest research or best practice in our disease areas. After all we only have to live with chronic disease every day. Best leave it all to the medics who know best, right?

Garth Marenghi said...

well it depends on your doctor,

in the NHS we will lose a rather magical thing if things continue to be privatised and that is the fact that doctors advise patients very objectively about the best management of their conditions,

the more privatised a service then the greater the conflicts of interest that will exist between the doctor's advice and the patient's best management,

take private surgery for example, it's always in the interests of the surgeon to carry out useless and pointless operations as they will still bring in the cash,

it's always best to take advice from someone who has nothing to gain from whatever you can be advised to have done as regards manegement

Fuddled Medic said...

Did I single out patients with chronic disease? I could be referring to myself 5 years ago wearing a magnet to try and cure a bruised knee. Perhaps I was talking about patients spending money buying lots of zinc treatment to try and cure the common cold?

in the NHS (to some extent) doctors dont have to worry about profit margins, but whats best for the patients. Its a shame that governments and the public dont seem to think that we care or give a damm about patients anymore, that we cant be trusted to make decisions and explain it to patients

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another one of those foolish patients with a chronic illness said... said...

"Did I single out patients with chronic disease? ......
Its a shame that governments and the public dont seem to think that we care or give a damm about patients anymore, that we cant be trusted to make decisions and explain it to patients."


Fuddled Medic

Your post is a good example of why some of the government and public don't automatically trust doctors to 'make decisions and explain it to patients'.

You try to comment with authority on a topic that you clearly know nothing about.

The government's proposed personal budget plan is for patients with long-term health conditions ie. chronic diseases, not for people with colds or bruised knees. See for example: http://www.pulsetoday.co.uk/story.asp?sectioncode=23&storycode=4123896

in the NHS (to some extent) doctors dont have to worry about profit margins, but whats best for the patients.

it's always best to take advice from someone who has nothing to gain from whatever you can be advised to have done as regards manegement

Except for when GPs decide to take a profit from savings made by putting patients on the cheapest medications rather than the medications that work best for the patient....
http://www.pulsetoday.co.uk/story.asp?sectioncode=40&storycode=4124023


Or when GPs profit by refusing to make needed referrals....

http://www.pulsetoday.co.uk/story.asp?storycode=4121287

At least in the private sector, motivating factors are transparent.

Anonymous said...

Who picks up the pieces if people run out of money? Do they get told "Sorry, you'll have to wait until the next financial year for further treatment"?

brett said...

Great subject. I have been playing around with the idea of the comment structure recently.


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Anonymous said...

Shame to see the NHS going downhill into this :( Where will the money go? Into PM's duck ponds and the like :(

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