Evolution of long-term care in the Netherlands: Cautionary perspectives? Fred Lafeber Ministry of Health, Welfare and Sport Long-term care department Presentation for the 2nd IAGG Africa region conference ‘LTC systems for Africa: setting agendas’ 6-9 December 2016

Present system Social Support Act (Wmo) Youth Care Act % of LTC Expenditures, 2015 Present system Social Support Act (Wmo) Social participation, cleaning; implemented by municipality Youth Care Act Care for young people; implemented by municipality Health Insurance Act (Zvw) Included here: long-term care at home (home care) financed from HIA (mandatory) implemented by private healthcare insurance companies. Long-term Care Act (Wlz) Care in nursing homes / homes for the elderly / institutional care for disabled people and people with chronic psychiatric disorders. This care may be delivered at home as well. The Wlz is a (mandatory) public long-term care insurance implemented by care offices that are a separate part of the private healthcare insurance companies

Reforms of LTC in 2015: three pillars Aging at home is norm. Less people in institutions Care at home delivered by health insurers and municipalities Normative reorientation. More individual and social responsibility!

Relevant perspectives for SSA? Relative role of formal LTC provision. Impact on solidarity and social contract. How to support and involve families in providing care? Broader impact of formal LTC on labour markets and productivity

Relative role formal vs. unpaid care Mixed evidence More formal care -> less commitment by family members and others to care! But still many family and other unpaid care workers (e.g. 10.000 volunteers for palliative care) Family/ volunteers Public ltc % of gdp Netherlands 14% 4,3% EU average 15% 1,3% Sources: Verbakel et al and OECD health data 2015

How to support (and involve) families in providing care? Individual society (older people live independent from their children, family care is not the rule). Part-time jobs and other arrangements will help finding the balance Still especially family care workers will face a burden and need support Special attention for role of women needed. Because the long-term care is characterized by large differences in quality among providers, has a strong supply-oriented character and has few incentives for care innovation… Establishment of outcome criteria: raising and insight into the quality and (more) reward quality and hatching-services; important role for the Inspectorate for Healthcare • the (more) next person making the financing; • future number and positioning of care offices; • translating interim results of the experiments in the context of experimental and pilot «better care at lower cost" and the results of the experiments rule poor settings; • separating the domains and development programs for the elderly and disabled in include quality and funding; • the establishment of a more direct relationship between the individual costs, such as the contribution, and the supplier of the service; • stimulating entrepreneurship and innovation and fostering care initiatives from below; • promoting the separation of living and care; • strengthening the involvement of the client in the organization of their own care;

Positive impact of formal LTC on labour market and productivity People can go to work even when someone in the family is dependent on care (50% combine care with a job). They contribute to Gdp. 400.000+ people work in long-term care

Thank you for your attention Any questions? fn.lafeber@minvws.nl