England must learn from other countries if it to avoid "unintended and negative consequences" of personal health budgets, experts have warned.
The Department of Health in England is currently exploring the possibility of personal health budgets to give patients more control over their care, and one option is for disabled and chronically-ill people to hold their own budget and pay directly for services to meet their needs. Pilot projects are underway in 64 Primary Care Trusts (PCTs).
However the Netherlands, which has had a similar system, is in the process of restricting it in light of several problems, according to Professor Martin McKee from the London School of Hygiene and Tropical Medicine and colleagues from the Netherlands, writing on bmj.com.
The Dutch Ministry of Health has argued that the system has become unsustainable, they write.
Since 1997, patients in the Netherlands have been able to hold a personal budget to purchase care, but during 2002-2010 the number of personal budget holders increased tenfold, while spending increased by an average of 23% a year. There have also been credible reports of fraud, and concerns about the growth of private agencies which broker arrangements between clients and providers, the researchers note.
"Unless the lessons of the Dutch experience are learnt, the unintended and negative consequences will outnumber the positive, empowering role of personal budgets," warn Prof McKee et al.
While some people have welcomed personal health budgets, many questions remain, they note. For example, how will the budgets be set? What will happen when the budgets are spent? Is there a risk that vulnerable individuals might be exploited by unscrupulous providers or brokering agencies?
A preliminary report has also shown that patients might spend their budget not only on conventional treatments but also on alternative ones, some of which - such as Reiki, reflexology and aromatherapy - are not supported by scientific evidence.
The authors ask: it is justifiable at a time of austerity to spend scarce resources on treatments known to be ineffective?
As a result of the problems in the Netherlands, the eligibility criteria for personal budgets there are set to change 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, the authors note.
"The UK government must also recognise that personal budgets can create new demand," they warn, adding: "consequently, eligibility rules and entitlements should be evaluated carefully to avoid creating false expectation and potentially disappointing many people."