however this is at the cost of ending the winwin situation where patients choose relatively cheaper cash benefits worth of the cost of inkind care that improve their own welfare thanks to a greater choice of providers and also encourage competition across home care providers thus it would be preferable to keep a cash benefits scheme for home care but to improve screening and monitoring to avoid unintended use one way of reducing the need for monitoring could be to provide cash benefits in the form of vouchers directly payable to professionals like in the nordic countries colombo et al to be effective such vouchers should be designed to cover less than the full costs of care where the implied copayment on each service purchased would give patients incentives for costefficient use of the vouchers such a focus could risk impeding the excellent dutch results in terms of equity and access to health care facilities however the increasing role of competition has not had a negative impact on equity so far