Personal Budgets, Choice and Health – a review of international evidence from 11 OECD countries: A Review of International Evidence from 11 OECD Countries

Personal or individual budgets for purchasing health and social care are intended to offer more choice, control and flexibility to service users when compared with agency-directed care. They are becoming an increasingly common feature in high-income countries for purchasing personal care that often lies on the border line between health and social care. In England, they have recently been introduced explicitly for the purchasing of health care. There are some key motivations behind their introduction: they are expected to give individuals more choice about care they receive; to expand options for care; to improve outcomes; and to reduce expenditure. This paper draws from a review of the international evidence on personal budgets which identified: descriptive detail on personal budget schemes in 11 OECD countries to examine their key features and implementation processes; empirical evidence on the experiences of, and outcomes for, people using these schemes, and; empirical evidence regarding the impact of the schemes on the healthcare system, particularly with regards to resources. The paper examines the motivating factors behind personal budget schemes in light of this evidence. It concludes that there is little in the evidence to suggest that international governments’ expectations for personal budget programmes are well-founded. The assumptions that they improve choice, and that more choice will in turn lead to greater autonomy and then improved outcomes at lower cost, are actually far more complex and generally unsupported by evidence

Testing Strategies to Enhance Online Student Collaboration in a Problem-Based Learning Activity

Most units of learning are being offered flexibly, either using distance education or online facilities, and often with asynchronous computer-mediated communication or online discussions. The use of asynchronous computer-mediated communication is believed to offer students the opportunity to communicate independently of time and place, and to ask questions, state opinions and offer advice when transferring interactive learning activities to an online environment. This chapter uses an action research framework to examine the quantity and nature of student engagement in a problem-based learning activity as a consequence of placing face-to-face instruction on and practice in problem-based learning prior to using asynchronous computer-mediated communication. The effectiveness of early placement of a 4-day residential component to improve student collaboration in the online problem-based learning activity was tested against six years (2001-2006) of electronically-archived online discussions in a 13-week, under- or post-graduate tertiary-level natural science unit