ABSTRACT Background: Policy instruments based on the working of markets have been introduced to empower consumers of healthcare, however it is not easy to become a critical consumer in healthcare. Objectives: The aim of this study is to analyze the possibilities of the state to strengthen the influence 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: Introducing individual budgets implies that the responsibility for budgetary control is shifted from the organizational level to the individual level of the caregiver-client relation. Offering more luxurious care necessitates a stronger demarcation of standard care because organizations cannot simultaneously offer extra care part of regularly care. Hence, new financial instruments influence the culture of care receiving and giving. 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 acted not only as a countervailing power against that are not client-oriented enough, but were also used by providers to reinforce their own position vis-à-vis demanding clients. Tailor-made finance is not the same as tailor-made care.

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Keywords Choice behavior, distributive justice, individual budgets, long term care
Persistent URL dx.doi.org/10.1136/jme.2009.030536, hdl.handle.net/1765/21907
Grit, K.J, & de Bont, A.A. (2009). Tailor-made finance versus tailor-made service. Journal of Medical Ethics: an international peer-reviewed journal for health professionals and researchers in medical ethics, 36(2), 79–83. doi:10.1136/jme.2009.030536