Two-thirds of hospital emergencies correspond to chronic patients’ decompensation which is why the health care system has a vested interest in helping people with chronic diseases to take care of themselves and learn to decrease their attendance to hospitals. Knowing that this can not be prescribed, the English have developed a system of budgetary self-accountability.
In 2009, the National Health Service launched a Personal Health Budget (PHB) Pilot Program in 70 localities and after an evaluation, it has been extended to the entire population, according to the following principles: People who need long term health and social care agree with their local professional teams (social services, primary care and NHS administrators) the arrangement of an amount of money that should allow them to reach the objectives of the individualized therapeutic plans previously agreed.
The PHB’s intention is that people with multi-pathologies or with degenerative or disabling diseases, have their service buying options nearby such as social services, psychological or physical therapy support. However, primary care services, pharmacies and hospitals are excluded. The first assessments offered by Nuffield Trust are positive in terms, particularly, of life quality. The economic aspects of the evaluation are more controversial as it is very difficult to quickly collect the savings of inappropriate hospital services that have been reduced thanks to PHB.
To get an idea, on the NHS website, page Personal Health Budget, you can see videos of accounts of various beneficiaries of the program and of the professionals involved. By way of example, I attach the case of Roger aged 58, afflicted with severe COPD, with decompensations that force him to be hospitalized often. Roger’s PHB has allowed him to acquire a portable nebulizer and a Wii Fit and join a gym. Now he feels more motivated to take care of himself, he has restarted garden activity and reduced medication.
In the last post of Patient Centred Coordination (PCC), I presented the case of Antonio, a complex chronic patient who consumed a huge amount of health and social services in his last 3 years of life, in a personal environment of scarcity of resources and very unsatisfying experience of the end of life. This English project of Personal Health Budget (PHB) would have been able to provide real support to Antonio’s daughter and would have facilitated a more realistic response to his care needs.