The Netherlands: the struggle between universalism and cost containment

Abstract

The Dutch home-care system is embedded in a universalistic and comparatively generous long-term care (LTC) scheme that was introduced in the late 1960s. The tension between guaranteeing access to good-quality care and controlling costs has been a key issue since the inception of the LTC scheme. The article addresses the question of how these two distinct objectives have been dealt with in the political debate and by policy-making in the past 20 years. It does so by looking at existing studies, official statistics and policy documents. First, the analysis shows that home care - the development of which results from the de-institutionalisation policies pursued since the 1980s - has shifted from being considered a cost-containment measure to representing a battlefield on cost containment. Second, the article argues that the issue of cost containment is a leitmotif in the development of home care that has been accompanied and legitimised over time by distinct normative views. On the one hand, traditional forms of cost containment - namely direct budgetary controls - have been predicated on the need to ensure the financial sustainability of the system and its universalistic features. On the other hand, the discourse and practice of cost containment has, since the early 1990s, also been accompanied by normative views that structurally challenge universalism through the introduction of new ideas about the responsibility for LTC risks, resource allocation and regulation of the system.

Perceived control in health care: A conceptual model based on experiences of frail older adults

“…A trend that can be observed is the rising focus of these governments on the encouragement of older adults to be in control of their health and health care (Angus & Reeve, 2006;Clark, 1987;Martin-Crawford, 1999;Roberts, 1999). In the Netherlands for instance, the current policy discourse stresses that older adults should function as independently as they possibly can (Da Roit, 2012).…”

Development and Difficulties of the Eldercare System in Croatia

“…Područje skrbi za starije stoga traži veću državnu intervenciju, što je u raskoraku s aktualnim pritiscima na javne financije te zahtjevima za smanjivanjem socijalnih troškova (npr. da Roit, 2012).…”

“…Unatoč različitostima, kod recentnih reformi nalazimo određene slič-nosti, koje se vide u većem kombiniranju novčanih davanja i usluga uz prioritet izvaninstitucionalnih usluga, pluralizmu pružatelja usluga i uvođenju elemenata tržišta u proces pružanja usluga (eng. marketization of care), privatizaciji te individualizaciji skrbi (vidi Pavolini i Ranci, 2008;Brennan, Cass, Himmelweit i Szebehely, 2012;da Roit, 2012;Glendinning, 2012;Kröger i Leinonen, 2012;Rostgaard i Zechner, 2012;Szebehely i Trydegård, 2012;Williams i Brennan, 2012).…”

“…Posebice raste popularnost shema kojima se osigurava naknada za skrb (eng. cash-for-care; da Roit, Le Bihan i Österle, 2007;da Roit, 2012;Le Bihan i Martin, 2012), ali i dopusti mogućnost prilagodbe radnoga vremena zbog pružanja dugotrajne skrbi (Le Bihan i Martin, 2012). Poluformalizacija skrbi čini granice između uobičajenih oblika skrbi, formalnih i neformalnih, plaćenih i neplaćenih, nejasnima (Pfau-Effinger i Geissler, 2005), dok u nekim zemljama (npr.…”

“…3 U zemljama srednje i južne Europe Bismarckova tradicija priječila je razvoj sveobuhvatnijih sustava skrbi za starije (Ranci i Pavolini, 2013). Stoga te zemlje karakterizira tradicija familizma, odnosno snažne usmjerenosti na obitelj koja zadržava socijalnu funkciju skrbi, što je često poduprto novčanim naknadama 4 (da Roit i sur., da Roit, 2012;Le Bihan i Martin, 2012;Theobald, 2012). Usluge su slabije razvijene i često rezidualnoga karaktera (Ranci i Pavolini, 2013), pa obitelji rješenje nerijetko traže u pružanju neformalne skrbi od migranata (Bettio i sur., 2006;da Roit i sur., 2007).…”