Politics, policy and payment--facilitators or barriers to person-centred rehabilitation?
OBJECTIVE
This paper explores the tensions between politics and payment in providing affordable services that satisfy the public demand for patient-centred care.


RESULTS
The two main approaches taken by the UK Government to curtail the spiralling costs of healthcare have been to focus development in priority areas and to cap spending through the introduction of a fixed-tariff episode-based funding system. The National Service Framework for Long Term Neurological Conditions embraces many laudable principles of person-centred management, but the 'one-size-fits all' approach to reimbursement potentially cuts right across these. A series of tools have been developed to determine complexity of rehabilitation needs that will support the development of banded tariffs. A practical approach is also offered to demonstrate the cost-efficiency of rehabilitation services for people with complex needs, and help to ensure that they are not excluded from treatment because of their higher treatment costs.


CONCLUSIONS
Whilst responding to public demand for person-centred care, we must recognize the current financial pressure on healthcare systems. Clinicians will have greater credibility if they routinely collect and share outcomes that demonstrate the economic benefits of intervention, as well the impact on health, function and quality of life.
Turner-Stokes
Lynne
L
Regional Rehabilitation Unit, Northwick Park Hospital, Department of Palliative Care, Policy and Rehabilitation, and King's College London School of Medicine, London, UK. lynne.turner-stokes@dial.pipex.com
D003362:Cost-Benefit Analysis; D003953:Diagnosis-Related Groups / Q000191:economics; D006233:Persons with Disabilities / Q000145:classification / Q000534:rehabilitation*; D017050:Episode of Care; D006291:Health Policy; D006292:Health Priorities / Q000191:economics*; D006301:Health Services Needs and Demand; D006801:Humans; D017059:Models, Econometric; D009422:Nervous System Diseases / Q000191:economics / Q000534:rehabilitation*; D017063:Outcome Assessment, Health Care; D018802:Patient-Centered Care / Q000191:economics*; D011057:Politics; D011788:Quality of Life; D012046:Rehabilitation / Q000191:economics; D012935:Social Justice; D013222:State Medicine / Q000191:economics; D006113:United Kingdom