Personalization in the health care system: do personal health budgets have an impact on outcomes and cost?
OBJECTIVE
In England's National Health Service, personal health budgets are part of a growing trend to give patients more choice and control over how health care services are managed and delivered. The personal health budget programme was launched by the Department of Health in 2009, and a three-year independent evaluation was commissioned with the aim of identifying whether the initiative ensured better health- and care-related outcomes and at what cost when compared to conventional service delivery.


METHODS
The evaluation used a pragmatic controlled trial design to compare the outcomes and costs of patients selected to receive a personal health budget with those continuing with conventional support arrangements (control group). Just over 1000 individuals were recruited into the personal health budget group and 1000 into the control group in order to ensure sufficient statistical power, and followed for 12 months.


RESULTS
The use of personal health budgets was associated with significant improvement in patients' care-related quality of life and psychological wellbeing at 12 months. Personal health budgets did not appear to have an impact on health status, mortality rates, health-related quality of life or costs over the same period. With net benefits measured in terms of care-related quality of life on the adult social care outcome toolkit measure, personal health budgets were cost-effective: that is, budget holders experienced greater benefits than people receiving conventional services, and the budgets were worth the cost.


CONCLUSIONS
The evaluation provides support for the planned wider roll-out of personal health budgets in the English NHS after 2014 in so far as the localities in the pilot sample are representative of the whole country.
Senior Research Fellow, Personal Social Services Research Unit, University of Kent, UK.
Karen
K
Jones
Julien
J
Forder
James
J
Caiels
Elizabeth
E
Welch
Caroline
C
Glendinning
Karen
K
Windle
D000328:Adult; D002017:Budgets; D002755:Choice Behavior; D003362:Cost-Benefit Analysis; D004739:England; D005260:Female; D005382:Financing, Personal; D005102:Health Expenditures; D006304:Health Status; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D010865:Pilot Projects; D015397:Program Evaluation; D058996:Quality Improvement; D011788:Quality of Life; D013222:State Medicine / Q000191:economics*; D011795:Surveys and Questionnaires
quality of life; quantitative methods; research policy