long term care in the netherlands aloys kersten dutch ministry of health, welfare and sports...
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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