This presentation was made by Patrick Jeurissen, Netherlands, at the 7th meeting of the Joint OECD DELSA/GOV Network on Fiscal Sustainability of Health Systems held at the OECD Conference Centre, Paris, on 14-15 February 2019

1. 0.00
2.00
4.00
6.00
8.00
10.00
12.00 1950
1953
1956
1959
1962
1965
1968
1971
1974
1977
1980
1983
1986
1989
1992
1995
1998
2001
2004
2007
2010
2013
2016
2019
Totale col. zorg
AWBZ
ZVW
overig (o.a. WMO)
Fiscal challenge: growing expenses (%GDP, Neth)

2. Towards patient-centred and fiscally sustainable long-term
care
High spending on LTC; high use LTC services; balance between residential
and non-residential care skewed; supply-driven, not patient-centred.
Reform implemented in 2015, which has 4 interrelated pillars:
Normative
reorientation
(more emphasis
on individual &
social
responsibility)
From residential
to non-residential
care
(‘ageing at home’)
Decentralization
of non residential
care
(‘bringing care
closer to people’)
Expenditure
cuts
(‘…’)
LTC reform
Source: Maarse & Jeurissen
(2015)

4. Was cost control in the Netherlands successful?
• Less growth in health expenses (2012 – 2018)
• Increase statutory deductible (€ 180 → € 385); increase voluntary risk
• Risk-bearing insurers (lower growth, when underwriting risks higher)
• National covenants (alignment of a fiscal goal)
• Less volume treatments outside hospital: mental health etc.
• Tendering generics (price)
• Decentralization social care
• Less benefits to people with less severe LTC case-mix

5. Expenditure cuts, but only for the short term

6. Topics for cost-control
• Forecasting: to much looking into the rear mirror?
• Costs skewed to the right: targeted or general approach?
• How to contain ‘transaction’ costs in a rapidly changing landscape?
• Competition or broad political alignment to prevent for overspending?
• Pricing strategies: administrative costs, task shifting, and technologies
• How to reward for value: P4P, ACO or softer teeth?
• Facing (downward) financial risk & alignment of (many) instruments
• Elephants in the room: (growing) needs for inpatient LTC, future of the hospital?

7. Out-of-pocket payments and social protection
OOP homecare: 0
Additional policies: 2019
Fixed contribution social: 17.50 /
month
Lower means testing for financial
assets: from 8% to 4%
Lower marginal rate: 12.5% to 10%