• Open Access

Individual budgets for people with incontinence: results from a ‘shopping’ experiment within the British National Health Service


Heather M. Gage PhD
Department of Economics
University of Surrey
Surrey GU2 7XH
E-mail: h.gage@surrey.ac.uk


Background and context  Most people with urinary incontinence are given limited choice when provided with absorbent products through the British National Health Service (NHS), even though the available range is large.

Objective  To investigate users’ preferences for four disposable designs (inserts, all-in-ones, belted/T-shaped and pull-ups) and towelling washable/reusable products, day and night.

Design  Shopping experiment.

Setting and participants  Community-dwelling women and men in England with moderate-to-heavy urinary incontinence recruited to a larger trial.

Intervention  Participants tested each design and selected products they would prefer with a range of different budgets.

Main outcome measures  Design preferences (rankings); ‘purchasing’ decisions from designated budgets.

Results  Eighty-five participants (49 men) tested products, 75 completed the shopping experiment. Inserts, most frequently supplied by the NHS, were ranked second to pull-ups by women and lowest by men. When faced with budget constraints, up to 40% of participants opted to ‘mix-and-match’ designs. Over 15 different combinations of products were selected by participants in the shopping experiment. Most (91%) stated a willingness to ‘top-up’ assigned budgets from income to secure preferred designs.

Discussion  Participants displayed diverse preferences. Enabling user choice of absorbent product design through individual budgets could improve satisfaction of consumers and efficiency of allocation of limited NHS resources.

Conclusion  Recent policy for the NHS seeks to provide consumers with more control in their care. Extension of the concept of individual budgets to continence supplies could be feasible and beneficial for patients and provide better value-for-money within the NHS. Further research is warranted.