Long term care in theNetherlands

Aloys KerstenDutch ministry of Health, Welfare and Sports

Barcelona, 14-10-2010

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Outline

• Short movie

• Dutch health care system

• Organization of long term care

• Developments in long term care

• Future developments

• Challenges

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Health Care System

• Cure – Health Insurance Actmedical treatments

• Care – Exceptional Medical Expenses Act

• Support – Social Support Actdomestic support, special transportation, home and living facilities

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Exceptional Medical Expenses Act : Functions

• Personal care

• Nursing

• Residence

• Treatment (not medical)

• Individual support

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Exceptional Medical Expenses Act : Clients

• Elderly (dementia, physical problems)

• Handicapped (mentally, physically)

• Persons with psychiatric problems

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Exceptional Medical Expenses Act : Organization

• Need of an individual

• In contact with an intermediate organization

• Apply for help at the Central Indication Bureau

• Zorgkantoor in each region

• Caretakers

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Exceptional Medical Expenses Act : Caretakers

• Private organizations without a profit goal

• Target groups

• Institutions vs home care

• Big concerns vs individual carers

• More than 600.000 employees

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Exceptional Medical Expenses Act : Number of clients

Client Institution Home care

Dementia 57.000 14.000

Elderly with physical problems

110.000 206.000

Handicapped

(mentally, physically)

65.000 40.000

Clients with psychiatric problems

25.000 60.000

Total 257.000 320.000

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Exceptional Medical Expenses Act : Costs

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Exceptional Medical Expenses Act : Mantelzorg

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Exceptional Medical Expenses Act : Developments

• Started in 1968

55.000 clients

less than € 1 billion

• 2010

600.000 clients

€ 23,5 billion (= 5% of GDP)

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Exceptional Medical Expenses Act : Developments

• 1968: only uninsurable risks for a limited group of people

• 2010: much more activities for a more extensive group of people

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Exceptional Medical Expenses Act : Developments

• Last 10 years: Quality gap

• Single rooms in institutions

• Lack of social participation

• Need of client is leading

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Exceptional Medical Expenses Act : Developments

Handicapped 2000 2010

Number of clients

103.000 105.000

(+ 2%)

Costs € 4,5 billion

(prices 2010)

€ 6,0 billion

(+ 33%)

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Exceptional Medical Expenses Act : Social Trends

• Ageing of Dutch population

• Globalization

• Regionalization

• Individualisation

• Technological developments

• Financial tenability

• Lack of staff

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Exceptional Medical Expenses Act : Future developments

• New government, new plans

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Exceptional Medical Expenses Act : Future developments

• Main policies for the long term care

• Extra investment of € 1 billion

• Assistance to the Social Support Act

• Revalidation to the Health Insurance Act

• Clients responsible for own housing

• Competitive insurers

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Exceptional Medical Expenses Act : Future developments

• Forecasts for 2015

• Costs from € 23,5 billion to € 28 billion

(+ 12%)

• Staff from 600.000 tot 680.000 employees

(+ 13%)

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Exceptional Medical Expenses Act : Challenges

• More innovations

• Lesser rules (high trust – high penalty)

• Investing in staff

• Stimulating labour participation

• Increasing self-sufficiency of care seekers