Sustainability of Comprehensive Universal Long‐term Care Insurance in the Netherlands

Abstract

The Netherlands was the first country that introduced a universal mandatory social health insurance scheme for covering a broad range of long-term care (LTC) services provided in a variety of care settings. Compared with most other OECD countries, both total and public expenditure on LTC is high, particularly since the Dutch population is relatively young. On the other hand, coverage of LTC services is relatively comprehensive. In this article we examine the past experiences, current deficiencies and future prospects of LTC financing in the Netherlands. By rationing of supply and tight budgetary restrictions, the government managed to effectively control the growth of LTC expenditure, but at the expense of growing waiting lists and deteriorating quality of care. Reform plans aim to make the LTC system more efficient and consumer-directed. We discuss whether the proposed reforms offer a perspective on a sustainable system of comprehensive LTC insurance. This is especially important in view of the ageing of the population and the expected increase in demand for LTC services. We conclude that the success of the reforms heavily depends on the definition of entitlements, the accuracy of needs assessment and the feasibility of determining appropriate client-based budgets.

Transitions in formal and informal care utilisation amongst older Europeans: the impact of national contexts

“…Since the 1990s, however, services in Sweden have become increasingly restricted to severely caredependent persons with limited familial and economic resources, whilst copayments have increased (Da Roit and Le Bihan 2010;Rauch 2008). Similar trends have been observed in the Netherlands (Schut and Van den Berg 2010), where stringent rationing policies were implemented during the 1990s, resulting in longer waiting lists. Increasingly, the availability of informal care has been taken into account in determining eligibility and entitlement amounts for publicly financed care.…”

Development and Difficulties of the Eldercare System in Croatia

“…Ovisnost u starijoj dobi prepoznaje se kao socijalni rizik tek unatrag dva desetljeća, kada počinje intenzivnije razmatranje i provođenje reformi koje vode formaliziranju skrbi, odnosno raste javna uključenost u reguliranje, financiranje, organiziranje i pružanje skrbi starijima (Rostgaard i Zechner, 2012). Veća uloga države ogleda se u sve većem obuhvatu uslugama dugotrajne skrbi, prepoznavanju prava na skrb kao socijalnoga prava, uvođenju osiguranja za dugotrajnu skrb i/ili u priznavanju neformalne skrbi (vidi Schut i Van den Berg, 2010;Rostgaard i Zechner, 2012;Le Bihan i Martin, 2012;Ranci i Pavolini, 2013). 1 Priznavanje neformalne skrbi vodi tzv.…”

“…2 Njima se pridružuje Nizozemska, pripadnica konzervativno-korporativnog režima, koja prva uvodi obvezno osiguranje za rizik od dugotrajne skrbi te razvija ekstenzivan sustav usluga (Schut i Van den Berg, 2010). 3 Radi se o manje homogenoj skupini.…”

Health Care Reform and Long-Term Care in the Netherlands

“…Securing cost-efficient provision of long-term care is key to mitigating spending pressures while maintaining high quality services -a difficult task for which international experience is still limited (Colombo et al, 2011;Schut and Van den Berg, 2010). In this context, the main challenges are to reorganise the system to improve efficiency incentives, to reduce further the dependence on institutional care, and to better target patients as the rapid uptake in the cash benefits system has exposed screening problems.…”