Regulators will be scrutinizing payments to ensure that any savings by insurance companies, government or other payers are not at the expense of quality. Providers will therefore be expected to be open about all their costs, with outcomes carefully monitored.
Carolyn Denne, Head of Service Quality Social Care Institute for Excellence, UK
In a number of countries, users have been given personal budgets in an attempt to increase their level of control and to personalize care. Some recipients – notably the very frail elderly – are less in favor of direct payments, due to the confusing array of choices and the administration. This approach can also lead to misuse or abuse, as individuals and families attempt to procure cash that will be used for other purposes; the use of vouchers can help reduce such a risk.
A report by the Health Foundation states that there is currently limited data showing whether direct payments improved quality, as most of the available research is descriptive rather than empirical, with a lack of conclusive data on the impact on health outcomes, quality and cost effectiveness.
In the US, Medicaid Cash and Counseling programs allow homebound, disabled patients to manage their own budgets and choose services that meet their needs. And in the Netherlands, citizens pay 12.15 percent of taxable earnings (up to a specified limit) into a fund that is used to purchase services (including residential care) for people with severe physical and mental disabilities.