From welfare state to
participatory society
Lessons from The Netherlands
7th Nordic Research Conference in Health Promotio...
PwC
Outline
1. Population ageing
2. Population ageing in The
Netherlands
3. Pressure on the welfare state
4. From welfare ...
PwC
1. Population ageing
Some global trends
Population ageing is a worldwide
phenomenon, caused by:
• Decrease in fertilit...
PwC
1. Population ageing
Old age dependency ratio in Europe in 2010
June 2013From welfare state to participatory society
4...
PwC
1. Population ageing
Old age dependency ratio in Europe in 2060
June 2013From welfare state to participatory society
5...
PwC
2. Population ageing in The Netherlands
Projections
• Strong increase of number and
proportion of elderly in the Dutch...
PwC
2. Population ageing in The Netherlands
Characteristics of ‘the group’ elderly
• ‘The elderly’ are a fast growing
grou...
PwC
2. Population ageing in The Netherlands
Characteristics of ‘the group’ elderly
In The Netherlands there are currently ...
PwC
2. Population ageing in The Netherlands
Semantic intermezzo
June 2013From welfare state to participatory society
9
Hea...
PwC
3. Pressure on the welfare state
Development of costs and use of healthcare
June 2013From welfare state to participato...
PwC
3. Pressure on the welfare state
Development of costs and use of healthcare
June 2013From welfare state to participato...
PwC
3. Pressure on the welfare state
Development of costs and use of healthcare
June 2013From welfare state to participato...
PwC
3. Pressure on the welfare state
Development of costs and use of healthcare
June 2013From welfare state to participato...
PwC
3. Pressure on the welfare state
Development of costs and use of healthcare
June 2013From welfare state to participato...
PwC
4. From welfare state to participatory society
Social support act
• Introduced in 2007 replacing the
‘Welzijnswet’ and...
PwC
4. From welfare state to participatory society
Basic principles of the Social support act
Municipalities are to work
t...
PwC
4. From welfare state to participatory society
Assumptions and ambitions in the social support act
Social
cohesion
Soc...
PwC
June 2013From welfare state to participatory society
18
4. From welfare state to participatory society
Ambitions and a...
PwC
June 2013From welfare state to participatory society
19
4. From welfare state to participatory society
Ambitions and a...
PwC
June 2013From welfare state to participatory society
20
4. From welfare state to participatory society
Ambitions and a...
PwC
June 2013From welfare state to participatory society
21
4. From welfare state to participatory society
Ambitions and a...
PwC
5. Lessons from the daily practice
Combination of changes
A new balance
between individuals,
‘social environment’
and ...
PwC
5. Lessons from the daily practice
What do we expect from each other?
Be honest and transparent in
communications towa...
PwC
5. Lessons from the daily practice
If there are financial relations, make
sure they are based on value addition
Don’t ...
PwC
5. Lessons from the daily practice
Identify needs and possibilities of the
person standing at the desk
Start with the ...
From welfare state to
participatory society
Lessons from The Netherlands
7th Nordic Research Conference in Health Promotio...
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Rene van Kujik NHPRC 2013

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From welfare state to participatory society

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Rene van Kujik NHPRC 2013

  1. 1. From welfare state to participatory society Lessons from The Netherlands 7th Nordic Research Conference in Health Promotion June 2013 www.pwc.nl
  2. 2. PwC Outline 1. Population ageing 2. Population ageing in The Netherlands 3. Pressure on the welfare state 4. From welfare state to participatory society 5. Lessons from the daily practice 2 June 2013From welfare state to participatory society
  3. 3. PwC 1. Population ageing Some global trends Population ageing is a worldwide phenomenon, caused by: • Decrease in fertility • Decrease in mortality rates • Higher life expectancy • Some Western European countries (and the US) faced a rapid temporary increase of birth rates shortly after WW2: The Babyboom Furthermore we see trends such as • Urbanization • Digitalization • Individualization • … June 2013From welfare state to participatory society 3
  4. 4. PwC 1. Population ageing Old age dependency ratio in Europe in 2010 June 2013From welfare state to participatory society 4 10-20% 20-30% 30-40% 40-50% 50-60% 60-70%
  5. 5. PwC 1. Population ageing Old age dependency ratio in Europe in 2060 June 2013From welfare state to participatory society 5 10-20% 20-30% 30-40% 40-50% 50-60% 60-70%
  6. 6. PwC 2. Population ageing in The Netherlands Projections • Strong increase of number and proportion of elderly in the Dutch society • Number and proportion of children is stabile …and that is relevant because? June 2013From welfare state to participatory society 6 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 0 2 4 6 8 10 12 14 16 18 Xmln 0-20 20-64 65+ Old age Young age
  7. 7. PwC 2. Population ageing in The Netherlands Characteristics of ‘the group’ elderly • ‘The elderly’ are a fast growing group, but also a extremely heterogeneous group June 2013From welfare state to participatory society 7
  8. 8. PwC 2. Population ageing in The Netherlands Characteristics of ‘the group’ elderly In The Netherlands there are currently about 2,6 million people over 65: June 2013From welfare state to participatory society 8 One out of five persons in The Netherlands is retired In 2010 there were 3 million households of elderly 800.000 elderly feel lonely 25% are at risk of health problems, moving to a nursing home or decease 150.000 live in a nursing home Elderly have a higher risk of life changing events The demand for healthcare will increase with 34% from 2006 to 2030 De demand for stay in a nursing home will increase with 40% and for home care with 32%
  9. 9. PwC 2. Population ageing in The Netherlands Semantic intermezzo June 2013From welfare state to participatory society 9 Health Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 1948) Dutch Translation What it contains (in Dutch) Gezondheid Health Absence of disease or infirmity Welvaart Welfare Prosperity and the extent to which needs can be satisfied with the available resources Welzijn Wellbeing Happiness, quality of life, satisfaction with life, participation, social interaction, conducting a household, mobility etc. Welvaart staat Welfare state Protection of collective interests and protection and promotion of prosperity Verzorging staat Welfare state Protection of well-being, social security, providing rights to (health)care
  10. 10. PwC 3. Pressure on the welfare state Development of costs and use of healthcare June 2013From welfare state to participatory society 10 Good health Bad health Lowuseof healthcare/ lowcosts Highuseof healthcare/ highcosts
  11. 11. PwC 3. Pressure on the welfare state Development of costs and use of healthcare June 2013From welfare state to participatory society 11 Good health Bad health Lowuseof healthcare/ lowcosts Highuseof healthcare/ highcosts
  12. 12. PwC 3. Pressure on the welfare state Development of costs and use of healthcare June 2013From welfare state to participatory society 12 Good health Bad health Lowuseof healthcare/ lowcosts Highuseof healthcare/ highcosts
  13. 13. PwC 3. Pressure on the welfare state Development of costs and use of healthcare June 2013From welfare state to participatory society 13 Good health Bad health Lowuseof healthcare/ lowcosts Highuseof healthcare/ highcosts In the welfare state: National government € Local government Qualityoflife
  14. 14. PwC 3. Pressure on the welfare state Development of costs and use of healthcare June 2013From welfare state to participatory society 14 Good health Bad health Lowuseof healthcare/ lowcosts Highuseof healthcare/ highcosts National governmentLocal government Shift from healthcare to promotion of participation
  15. 15. PwC 4. From welfare state to participatory society Social support act • Introduced in 2007 replacing the ‘Welzijnswet’ and the ‘Wet voorzieningen gehandicapten’ • The Social Support Act aims to promote participation and well- being of citizens: • As a goal in itself • As a mean to directly prevent people from getting ill and use of healthcare • As a mean to strengthen social infrastructures and informal (community) care and by doing so preventing use of healthcare June 2013From welfare state to participatory society 15
  16. 16. PwC 4. From welfare state to participatory society Basic principles of the Social support act Municipalities are to work together with other (professional) organizations Transfer of participation and well- being and tasks to local parties under supervision of municipalities. 1 Services are to be tailored to individual needs and circumstances Shift from ‘right to care’ to freedom of policy for municipalities. 2 People are responsible for solving their own problems and arranging support Making society itself responsible for its own wellbeing and welfare 3 People are to look after one another and support each other A larger appeal on ‘the civil society’ 4 16 June 2013From welfare state to participatory society Principle Implication
  17. 17. PwC 4. From welfare state to participatory society Assumptions and ambitions in the social support act Social cohesion Social and societal participation June 2013From welfare state to participatory society 17 Informal and ‘Community care’ (Local) Government • Reinforcement hypothesis • Crowding-out hypothesis
  18. 18. PwC June 2013From welfare state to participatory society 18 4. From welfare state to participatory society Ambitions and assumptions in the social support act ? Need for support in • Conducting a household • Moving in and outside the house • Meeting other people and forming social relationships From 2015 • Day care and guidance • Transportation
  19. 19. PwC June 2013From welfare state to participatory society 19 4. From welfare state to participatory society Ambitions and assumptions in the social support act individual familyfriends, neighbours ?!?
  20. 20. PwC June 2013From welfare state to participatory society 20 4. From welfare state to participatory society Ambitions and assumptions in the social support act individual familyfriends, neighbours ‘civil society’ !?
  21. 21. PwC June 2013From welfare state to participatory society 21 4. From welfare state to participatory society Ambitions and assumptions in the social support act individual familyfriends, neighbours ‘civil society’ prof. organ. govern- ment !
  22. 22. PwC 5. Lessons from the daily practice Combination of changes A new balance between individuals, ‘social environment’ and government A new balance between government and its partners June 2013From welfare state to participatory society 22 From governmental responsibility to individual and societal responsibility From diagnosis- treatment to tailoring support to needs From government to ‘professional organizations’ under direction of local government Inter face
  23. 23. PwC 5. Lessons from the daily practice What do we expect from each other? Be honest and transparent in communications towards people 1 What’s in it for them? Or is it just a cost cutback? Focus on advantages for target groups 2 What do we expect from the ones that need to provide that support? Are they involved? Don’t just focus on those who need support, but also on ‘the young’ 3 Guide the transition from ‘right to care’ to ‘compensation when in need of support’ Consider it to be a cultural change 4 How to assess one’s needs and possibilities (alone and with social environment) Know the people 5 23 June 2013From welfare state to participatory society
  24. 24. PwC 5. Lessons from the daily practice If there are financial relations, make sure they are based on value addition Don’t consider it to be a ‘procurement’ issue 1 Accept differences in organizational goals. Societal effects bind organizations Focus on ‘goals at the societal level’ 2 Make sure roles, responsibilities and tasks are clear and accepted Strive for ideological and domain consensus in roles, responsibilities and tasks 3 Choose a role that fits the situation and context and make sure it is politically covered Local governments have a crucial role and have to fill that carefully 4 Find other ways of governing a network, for example via trust Formal vertical hierarchy is often absent 5 24 June 2013From welfare state to participatory society
  25. 25. PwC 5. Lessons from the daily practice Identify needs and possibilities of the person standing at the desk Start with the person in front of you in mind 1 Bundle and coordinate service delivery around patients Organize around the demand for support 2 Proactive service delivery is aimed at prevention and improvement of one’s social infrastructure Combine reactive and proactive service delivery 3 25 June 2013From welfare state to participatory society
  26. 26. From welfare state to participatory society Lessons from The Netherlands 7th Nordic Research Conference in Health Promotion June 2013 www.pwc.nl © 2013 PwC. All rights reserved. Not for further distribution without the permission of PwC. "PwC" refers to the network of member firms of PricewaterhouseCoopers International Limited (PwCIL), or, as the context requires, individual member firms of the PwC network. Please see www.pwc.com/structure for further details.

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