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Long term care in the Netherlands Aloys Kersten Dutch ministry of Health, Welfare and Sports Barcelona, 14-10-2010 Outline • • • • • • 2 Short movie Dutch health care system Organization of long term care Developments in long term care Future developments Challenges 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 3 Exceptional Medical Expenses Act : Functions • • • • • 4 Personal care Nursing Residence Treatment (not medical) Individual support Exceptional Medical Expenses Act : Clients • Elderly (dementia, physical problems) • Handicapped (mentally, physically) • Persons with psychiatric problems 5 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 6 Exceptional Medical Expenses Act : Caretakers • • • • • 7 Private organizations without a profit goal Target groups Institutions vs home care Big concerns vs individual carers More than 600.000 employees Exceptional Medical Expenses Act : Number of clients Client Dementia Elderly with physical problems Handicapped (mentally, physically) Clients with psychiatric problems Total 8 Institution Home care 57.000 14.000 110.000 206.000 65.000 40.000 25.000 60.000 257.000 320.000 Exceptional Medical Expenses Act : Costs 9 Exceptional Medical Expenses Act : Mantelzorg 10 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) 11 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 12 Exceptional Medical Expenses Act : Developments • Last 10 years: Quality gap • Single rooms in institutions • Lack of social participation • Need of client is leading 13 Exceptional Medical Expenses Act : Developments Handicapped 2000 2010 Number of clients 103.000 Costs € 4,5 billion (prices 2010) 105.000 (+ 2%) € 6,0 billion (+ 33%) 14 Exceptional Medical Expenses Act : Social Trends • • • • • • • 15 Ageing of Dutch population Globalization Regionalization Individualisation Technological developments Financial tenability Lack of staff Exceptional Medical Expenses Act : Future developments • New government, new plans 16 Exceptional Medical Expenses Act : Future developments • Main policies for the long term care • • • • • 17 Extra investment of € 1 billion Assistance to the Social Support Act Revalidation to the Health Insurance Act Clients responsible for own housing Competitive insurers 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%) 18 Exceptional Medical Expenses Act : Challenges • • • • • 19 More innovations Lesser rules (high trust – high penalty) Investing in staff Stimulating labour participation Increasing self-sufficiency of care seekers