1. Long term care in the Netherlands Aloys Kersten Dutch ministry of Health, Welfare and Sports Barcelona, 14-10-2010

2. 2 Outline Short movie Dutch health care system Organization of long term care Developments in long term care Future developments Challenges

3. 3 Health Care System Cure – Health Insurance Act medical treatments Care – Exceptional Medical Expenses Act Support – Social Support Act domestic support, special transportation, home and living facilities

4. 4 Exceptional Medical Expenses Act : Functions Personal care Nursing Residence Treatment (not medical) Individual support

5. 5 Exceptional Medical Expenses Act : Clients Elderly (dementia, physical problems) Handicapped (mentally, physically) Persons with psychiatric problems

6. 6 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

7. 7 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

8. 8 Exceptional Medical Expenses Act : Number of clients ClientInstitutionHome care Dementia57.00014.000 Elderly with physical problems 110.000206.000 Handicapped (mentally, physically) 65.00040.000 Clients with psychiatric problems 25.00060.000 Total257.000320.000

9. 9 Exceptional Medical Expenses Act : Costs

10. 10 Exceptional Medical Expenses Act : Mantelzorg

11. 11 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)

12. 12 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

13. 13 Exceptional Medical Expenses Act : Developments Last 10 years: Quality gap Single rooms in institutions Lack of social participation Need of client is leading

14. 14 Exceptional Medical Expenses Act : Developments Handicapped20002010 Number of clients 103.000105.000 (+ 2%) Costs€ 4,5 billion (prices 2010) € 6,0 billion (+ 33%)

15. 15 Exceptional Medical Expenses Act : Social Trends Ageing of Dutch population Globalization Regionalization Individualisation Technological developments Financial tenability Lack of staff

16. 16 Exceptional Medical Expenses Act : Future developments New government, new plans

17. 17 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

18. 18 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%)

19. 19 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