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Dr Albertjan Tollenaar: ‘Providing healthcare in kind is the only way to solve fraud with personal healthcare budgets’

08 May 2013

News reports of fraud with social welfare benefits are becoming increasingly common. Rent and healthcare allowances are being wrongfully granted to what are known as ‘phantom citizens’ and mediators are fiddling personal healthcare budgets (pgbs). The State Secretary for Health, Martin Van Rijn, recently announced more stringent checks in an effort to counter benefit abuse. But according to Albertjan Tollenaar, lecturer in administrative law at the University of Groningen, this is not the solution. He thinks that the answer lies in providing healthcare in kind.

Albertjan Tollenaar
Albertjan Tollenaar

‘The government cannot provide citizens with what they want and is instead giving citizens a stash of money to sort it out for themselves’, says Tollenaar. ‘Personal healthcare budgets have been growing in popularity since early 2005. Supposedly to give citizens more choice, but there are also other, less honourable, reasons. We are now seeing a market of people intent on earning a quick dime by setting themselves up as mediators. This group currently operates just inside the limits of the law.’

Government underestimates administrative capacities

Tollenaar is keen to stress that most people who receive a personal healthcare budget are honest citizens. ‘But even honest people can abuse social welfare benefits if they fail to understand or don’t know where to go. They may spend the budget they’ve been allocated on the wrong thing, for example. This is often because they have failed to understand. The government expects citizens to be able to perform administrative tasks they are simply not capable of doing.’

More stringent checks ill-advised

Of course there is also a group of intentional fraudsters. Tollenaar: ‘All rules are subject to abuse, but fraudsters need to be rooted out. This is why the Secretary of State has announced more stringent checks in the short term . Twenty percent of those receiving a personal healthcare budget can expect a visit from an inspector sometime during the next eighteen months.’

Tollenaar is not overly enthusiastic about this measure. ‘It will not stop the majority of fraudsters from abusing the system. Furthermore, extra checks will cause a greater administrative burden, both to citizens and to government. One percent of the healthcare budget must now be set aside for overheads. This amount will not be spent on satisfying healthcare needs, but on civil servants. This is ill-advised in these times of austerity.’

Too much choice

So what can be done to counter fraud? ‘There is far too much choice for people with a personal healthcare budget and the instrument has become too popular’, says Tollenaar. ‘People are happy with the instrument, which they see as extra monthly income. But you could say: someone who needs a mobility scooter should be given a mobility scooter rather than a budget to help with transport costs. If they want a different model, they can sort that out for themselves.’

Healthcare in kind is the best solution

According to Tollenaar, the vast majority of healthcare needs can be catered to in kind . ‘Most of these things are very easy to organize if you have good collective amenities. This ensures that the money goes to the people who are entitled to it. You can sit down with the people who need more than the collective amenities have to offer and discuss their personal requirements. What we should not be doing is giving people money, waiting for them to misspend it and then trying to repair the damage. It’s a waste of time as most of the money can never be retrieved.’

More efficient government enforcement

Tollenaar: ‘In the short term, the government needs to enforce the rules more efficiently. It could, perhaps, link databases, analyze applicants and check whether they have a history of benefit fraud. It could also compile risk profiles to keep a close eye on certain applicants. Another option would be to persuade applicants that a personal healthcare budget is not the best solution, or even to refuse certain applicants a personal healthcare budget if there is reasonable doubt about how it will be spent. This last measure is already a possibility, but local authorities are unwilling to use it as grounds for refusing an application.’

In Tollenaar’s view, similar measures could also apply in organizations that receive a lot of money via personal healthcare budgets. ‘You could introduce quality criteria, check certificates and quality marks. These are all tried and tested instruments for ensuring that money is well spent.’

Curriculum Vitae

Albertjan Tollenaar (Swifterbant, 1978) is a postdoctoral researcher and lecturer in the Department of Administrative Law & Public Administration, and a fellow of the Groningen Graduate School of Law. He is involved in the ‘Safeguarding public interests in more privatised social security’ research project, and other positions include project coordinator of the Nuffic-funded cooperation project with Mzumbe University in Tanzania.

Last modified:15 September 2017 3.10 p.m.
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