The Netherlands
Demographic information (CBS/Statistics Netherlands, 2010)
- Inhabitants: 16,574,989
- No. of citizens >65: 2,538,328
- No. of citizens >75: 1,143,821
- No. of people with long-term care needs: about 415,000 (officially assessed, 2007)
Characteristics of health, social and long-term care
The Netherlands is a parliamentary democracy with twelve provinces and 418 municipalities. The national government is responsible for health care, long-term care and general social insurance matters. The municipalities are responsible for social assistance and social care. Long-term care is funded by the Exceptional Medical Expenses Act, acute care by the Health Insurance Act and social care by the Social Support Act. The Netherlands hold a centralistic and egalitarian view on health care and long-term care. It is highly valued that people are treated equally, in spite of differences in socio-economic background. Only recently, services for well to do people have emerged on a larger scale, often in the private for-profit sector, whereas the vast majority of care is provided by private not-for-profit providers. Moreover, regional differences are limited. Where differences exist, this is often a consequence of the age distribution of the population and characteristics the local labor market.
All Dutch citizens are insured for long-term care as covered by the Exceptional Medical Expenses Act. The Social Support Act focuses on social participation and is tax based. The above mentioned acts complement each other in theory and in practice, but interlinking between the systems is not always to accomplish. Most of the care is provided in kind, but a rapidly increasing share is funded by personal budgets. This facilitates more diversity in care provision. However, personal budgets are hardly subject to any external control and are sometimes misused for other purposes.
A simplified illustration of LTC provision in The Netherlands
Download here a simplified illustration of possible LTC pathways for Mr. D. Care.
Background information on key-issues
Prevention and rehabilitation in LTC
(...) The increase of the number of people with chronic diseases requires a coherent and multidisciplinary care, which is extended close to the patient. It is forecasted that in 2020 4 to 6 million people suffer from one or more chronic diseases. Government will therefore continue to improve prevention of diseases. Care insurers are increasingly rewarding healthy lifestyle of their enrolees. Collective prevention is a responsibility of municipalities. There is a growing interest in prevention in older people, as positive effects are becoming more evident.
In the older age groups much prevention is focused on secondary and tertiary prevention, in order to avoid long standing dependency. However, primary prevention appears to be effective as well in older people.
The number of people with dementia is expected to rise to more than 380,000 by 2030. Therefore, a great number of services have been developed to slow down the dementia process, but – possibly more important at this moment - to support informal carers and to exchange good practice and mutual support. Meeting centres, Alzheimer Cafes, day centres and case management are examples of good practice that may postpone intensive use of services (more ...)
Quality assurance and quality management in LTC
(...) The main element of quality improvement in long-term care for older people is the obligation of care organisations to deliver so-called ‘responsible care’ (verantwoorde zorg). This should be achieved by an active quality policy, a quality implementation system, and the publication of an annual quality report, to be sent specifically to the Minister of Health and to the regional organisation of patients and care customers. A System of mandatory quality performance measurement was introduced in 2009. It is based on a specification of what is meant by ‘responsible care’. In Dutch health care policy a paradigm shift is becoming quite evident: a move from quality of care towards quality of life. This shift that started in care for persons with (mental) disabilities in the mid-1990s is being adopted now by long term care for older people as well. From this shift, it is easily understood that a perspective is emerging that focuses on the client’s natural social network rather than on the care providers’ interests; a change from a focus on process towards a focus on outcome as expressed in the experience of the client.
Care organisations are supposed to operate on a regulated market: they have to compete on the basis of price and quality for their annual contracts with the Care Office. The Health Care Inspectorate (IGZ) effectively enforces quality management of health services (including long-term care), prevention measures and medical products. It advises, encourages and stimulations quality measures, However, if necessary it may enforce quality measures.
The inspectorate uses the following methods: enforcement measures, phased supervision, investigation of incidents and monitoring based on themes. It intensively monitors negligent suppliers, and even may close the care organisation in case of repeated violation of rules. All care suppliers are obliged to submit and publish their quality indicator figures.
Besides this legal basis for quality management, many organisations participate in voluntary systems of accreditation and certification, which is often a requirement of health care insurers (more ...)
Governance and financing of LTC
(...) Governance of long-term care and health care is a corporatist endeavor in the Netherlands, with many stakeholders involved. The health care insurers and the regional care offices are responsible for purchasing services. The National Care Authority ensures conditions for competition and setts tariffs. The Centre for assessments of care ensures independent needs assessment, which are the basis for eligibility testing. The Health Insurance Board has a responsibility for the coverage of care packages and their financial consequences. It also monitors the care offices. The Central Administration Office calculates and cashes user shares. It takes into account income tax data, as it has access to the national tax office. It also finances care organisations within the agreements made between them and the Care Office in their region. The Health Care Inspectorate monitors quality of care and the Ministry of Health Welfare and Sports carries system responsibility (more ...)
