• K Grit and A de Bont.
• Institute of Health Policy & Management, Erasmus University Rotterdam, Postbox 1738, 3000 DR Rotterdam, The Netherlands. grit@bmg.eur.nl
• J Med Ethics. 2010 Feb 1; 36 (2): 79-83.

BackgroundPolicy 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.ObjectivesThe 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.MethodsData were collected through in-depth interviews with executives, managers, professionals and client representatives of six long-term care institutions.ResultsWith 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'.ConclusionFinancial 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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