An international trend to self-directed care

Critics of consumer-directed health care often argue that patients are not knowledgeable enough and the market is not transparent enough for consumerism to work in health care. But a study by The Commonwealth Fund says there is an international trend toward self-directed care (SDC) and it is focused on a most unlikely group of patients: the frail, the old, the disabled and even the mentally ill, says John C. Goodman, President, CEO and the Kellye Wright fellow of the National Center for Policy Analysis.

For example:

In the United States, Medicaid "Cash and Counselling" programs – underway for over a decade – allow home bound, disabled patients to manage their own budgets and choose services that meet their needs.

In Germany and Austria, a cash payment is made to people eligible for long-term care – with few strings attached and little oversight on how the money is used.

In England and the Netherlands, the disabled and the elderly manage budgets in a manner similar to Cash and Counselling in the United States.

Also in the US, Florida and Texas have SDC programmes for patients with serious mental illness and the Veterans Administration has an SDC program operating in 20 states for long-term care and mental illness.

Further, it appears that we have barely scratched the surface in taking advantage of patient power opportunities. The greatest potential in this area is in the treatment of chronic illness. Studies show that chronic patients can often manage their own care with results as good or better than under traditional care; and if patients are going to manage their own care, it makes sense to allow them to manage the money that pays for that care, says Goodman:

The British National Health Service (NHS) is already contributing to SDC budgets for muscular dystrophy, severe epilepsy and chronic obstructive pulmonary disease.

The NHS believes it is saving money in reduced hospital and nursing home costs.

The NHS is also about to launch pilot programs that will include mental health, long-term chronic conditions, maternity care, substance abuse, children with complex health conditions and end-of-life care.

The advantage of empowering patients and families in this way are straightforward: lower costs, higher quality care and higher patient satisfaction, explains Goodman.

Source: John C. Goodman, An International Trend Toward Self-Directed Care, Health Affairs, April 9, 2010.

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First published by the National Center for Policy Analysis, Dallas and Washington, USA

FMF Policy Bulletin/ 20 April 2010

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