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Tailor-made finance versus tailor-made care. Can the state strengthen consumer choice in healthcare by reforming the financial structure of long-term care?
  1. K Grit,
  2. A de Bont
  1. 1Institute of Health Policy, Erasmus University Rotterdam, Rotterdam, The Netherlands
  2. 2Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
  1. Correspondence to Dr K Grit, Institute of Health Policy & Management, Erasmus University Rotterdam, Postbox 1738, 3000 DR Rotterdam, The Netherlands; grit{at}


Background Policy instruments based on the working of markets have been introduced to empower consumers of healthcare. However, it is still not easy to become a critical consumer of healthcare.

Objectives The aim of this study is to analyse the possibilities of the state to strengthen the position of patients with the aid of a new financial regime, such as personal health budgets.

Methods Data were collected through in-depth interviews with executives, managers, professionals and client representatives of six long-term care institutions.

Results With the introduction of individual budgets the responsibility for budgetary control has shifted from the organisational level to the individual level in the caregiver-client relationship. Having more luxurious care on offer necessitates a stronger demarcation of regular care because organisations cannot simultaneously offer extra care as part of the standard care package. New financial instruments have an impact on the culture of receiving and giving care. Distributive justice takes on new meaning with the introduction of financial market mechanisms in healthcare; the distributing principle of ‘need’ is transformed into the principle of ‘economic demand’.

Conclusion Financial instruments not only act as a countervailing power against providers insufficiently client-oriented, but are also used by providers to reinforce their own positions vis-à-vis demanding clients. Tailor-made finance is not the same as tailor-made care.

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  • Funding De Open Ankh, a network of 10 Dutch care organisations.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • i For more information on the Dutch healthcare system, see the English version of the website of the Ministry of Health, Welfare and Sport (

  • ii Except, of course, in acute situations, people in The Netherlands needing long-term care must first be deemed to have a medical condition (‘indication’) before care can be delivered. In publicly financed systems, the state always holds some control over the way money is spent. In this case, the Ministry of Health stated explicitly that the new financial structure is not part of a policy of retrenchment, because the government has not changed the macro budget for long-term care.