This presentation was made by Albert Veraart, Netherlands, at the 6th Meeting of the Joint OECD DELSA-GOV Network on Fiscal Sustainability of Health Systems, held at the OECD Conference Centre, Paris, on 18-19 September 2017

1. Overview of
Long Term Care reforms
in the Netherlands
September 2017
Department of Long-Term Care

2. 1. Some Key Figures
2. Long-Term Care reform: why?
3. Long-Term Care measures
4. Lessons Learnt
Outline

3. Some Key Figures: Healthcare in the Netherlands
Source: CBS, Ministry of VWS3
Population (x 1 mln): 2017 2040
total 17,0 18,0
0-65 14,0 13,3
65+ 3,0 4,7
-->of which 80+: 0,7 2,0
Life Expectancy: women 83.3 years / men 79.9 years
Total expenditure on healthcare 2018:
Percentage GDP:
Long-Term Care:
Elderly Care:
€ 72.6 billion
10%
€ 29.6 billion
€ 18.2 billion

4. Figures: LTC in the Netherlands
Voettekst4

5. Figures: Development inpatient LTC in the Netherlands
5
0%
10%
20%
30%
40%
50%
60%
70%
0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
1,800,000
2,000,000
1980 "90 "00 "10 "20 "30 2040
Inpatientplacesper80+
Numberof80+yrs
Inpatient per 80+ HIGH inpatient per 80+
80+ yrs 80+ yrs (forecast)
Right axis
Left axis 

6. Figures: LTC international comparison
6
5.3
1.3
0.5
0.9
7.7
3.0
2.2
2.1
4.2
3.6
0.8
0.2
0.4
3.5
1.4
1.3
1.7
2.2
0.0 1.0 2.0 3.0 4.0 5.0 6.0 7.0 8.0
Sweden
Spain
Slovenia
Poland
Netherlands
Luxembourg
Germany
France
Finland
(LTC in % of GDP)
2008 2050

7. Long Term Care reform: why?
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• Financial burden : high & rising
• Ageing Population
• Changing values in Dutch society

8. Reform LTC: process
• Goals:
o Decreasing percentage LTC expenditure of GDP
o Improve balance formal and informal care
o Improve quality of care  more person-centred care
• Introduction legislation in 2015
• Gradual implementation of Long Term Care Act (Wlz)
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9. Reform LTC: measures
• Focus on care at home, reduction institutional care (2013)
• Stimulating informal care;
• Formal care more tailor-made
• Budget household care (cleaning): -/-40% (2015)
• A new Long-term Care Act; only for people that need care and
supervision 24 hrs a day.
• Parts of the former ‘LTC’ (AWBZ) are shifted to:
• Private care: Health Care Insurance Act
• Municipalities : renewed Social Support Act (SSA) and Youth Care
Act
• Care that is part of the SSA is only granted if the (financial) resources
of persons seeking care are insufficient (means testing)
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10. Budget LTC divided since 2015:
Social Support Act (Wmo)
Social participation; Support informal carers, protected living en shelter, client support,
Municipality responsible
Youth Care Act
Care for young people and their parents, Social participation,
Municipality responsible
Health Insurance Act (Zvw)
(mandatory) private healthcare insurance: GP’s / therapists / medication / hospital care /
specialists / ambulance transport / audiovisual and locomotory aids / disctrict nurse / personal care
Long-term Care Act (Wlz)
The Wlz is a (mandatory) public long-term care insurance: nursing homes / (homes for the elderly)
/ care at home / institutional care for disabled people and people with chronic psychiatric disorders
66%
16%
13%
4%

11. Reform of LTC: results in €
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25,000
26,000
27,000
28,000
29,000
30,000
31,000
2012 2013 2014 2015 2016 2017
Expenditures LTC Netherlands 2012-2017
(*€ mln)
After policy change Base (no policy change)

12. Lessons learnt
1.Social & political support is essential
2. Not only focus on cuts, also on quality
3. It takes time to make it work
4. Challenges:
• Increasing demand for care & decreasing labor
force
• Despite Reform LTC still high & rising
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13. Thank you for your attention
Any Questions?
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