The Long Term Costs of Lifestyle Risks. Pathways to Change: A Case Study in the UK

7. Healthy Living Bonuses

Service users can also play a crucial role in ensuring that resources are used to address their health needs in the most cost effective ways possible. In recognition of this there have been recent developments in the provision of social care that have marked a change in the relationship between government and the individual. In particular, pilot schemes giving patients with long-term conditions a personal budget to decide their own care needs were advocated by the Prime Minister’s Strategy Unit in 2005 in Improving the Life Chances of Disabled People. Sussex was designated as the first pilot site and individual budgets have been in use since 2005.

The outcomes of individual budgets have been largely positive, with 47% of those who accepted the pilot offer reporting that their view of what could be achieved in their lives had changed significantly48. These pilot schemes emphasise the vast benefits of providing the resources to empower individuals to exercise more control over their own health. The success of individual budgets has led to the Health Minister Lord Darzi advocating the expansion of their use for long-term conditions.

Individuals can also be incentivised to take greater responsibility, through co-payment and healthy living bonuses.

8. Increasing Scope for Self-Payment

A key approach for improving incentives for individual responsibility would be to move towards a public health service that encourages and enables individuals to make a positive change in their behaviour. Two key features of this are increasing scope for self-payment and encouraging greater individual responsibility.

The funding of public services is no longer the exclusive responsibility of government, with the notion of topping-up services becoming more accepted in areas such as health and education. Until recently patients who chose to top up their NHS care with private treatment, or by purchasing drugs unavailable on the NHS, were denied its services, although the legality of such a position had been questioned.

Following a review of this policy, the ban on NHS top ups is to be lifted and will be allowed under a series of strictly regulated conditions. This is a positive step as it affords the individual more control over their healthcare, as well as allowing them access to previously off-limit medicines, however this reform must go further to create a competitive, patient-focused health service.

9. Conclusion

The recommendations in this paper are particularly important given the economic situation. The very difficult position of the public finances inevitably means that government’s ambitions will have to be scaled back and greater role taken by individuals and employers.

The consistent message of this research is that more responsibility for individuals and employers and better health and greater productivity go together. Healthier individuals and workplaces will ameliorate the effects of the recession and advance the recovery. Greater personal responsibility will have a greater impact and reduce the burden on government. The result will be a new culture of health and enterprise in the UK.

This is particularly important for the future economic security of the 40-60 age group. Such programmes will assist them to remain in employment and improve their health in later age. In the UK and across all of Europe effective action can be taken now to change what seems to be an inevitable increase in costs due to ageing.

48 Department of Health (2008): Evaluation of the Individual Budgets Pilot Programme Final Report.

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