Netherlands: Long-Term Care - Health Systems Facts

Netherlands Health System Overview
Health System Rankings
Outcomes
Health System Coverage
Costs for Consumers
Health System Expenditures
Netherlands COVID-19 Policy

Health System Financing
Health System Personnel
Health System Physical Resources and Utilization
Long-Term Care
Health Information and Communications Technologies
Medical Training
Pharmaceuticals

Political System
Economic System
Population Demographics
Health System History and Development
Health System Future Challenges

Population, Mid-Year 2019: 17,097,000
Projected Population Mid-Year 2030: 17,450,000
Percentage of Population Under Age 25 Years, Mid-Year 2019: 28%
Percentage of Population 65 Years Or Over, Mid-Year 2019: 20%

Source: United Nations, Department of Economic and Social Affairs, Population Division (2019). World Population Prospects 2019: Data Booklet (ST/ESA/SER.A/424).
https://population.un.org/wpp/Publications/Files/WPP2019_DataBooklet.pdf
https://population.un.org/wpp/

Percent of Adults Aged 65 and Over Receiving Long-Term Care (2017): 13.0*
Percent of Adults Aged 65 Years and Over Reporting To Be In Fair, Bad, or Very Bad Health (2017): 39.8%
People With Dementia Per 1,000 Population (2019): 16.8%
Projected Number of People With Dementia Per 1,000 Population in 2050: 32.8%
Long-Term Care Workers Per 100 People Aged 65 And Over (2016): 8.0
Long-Term Care Beds In Institutions and Hospitals Per 1,000 Population Aged 65 And Over (2017): 76.4
Long-Term Care Expenditure (Health and Social Components) By Government and Compulsory Insurance Schemes, as a Share of GDP (%) (2017): 3.7%
(*Note: “Refers to social-insurance funded LTC only: the fall in recent years largely reflects the transfer of many LTC services to municipalities in 2015.”)

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

Formal Long-Term Care Workers At Home (Head Count) (2018): 100,000
Formal Long-Term Care Workers In Institutions (Head Count) (2018): 155,000
Long-Term Care Recipients In Institutions Other Than Hospitals (2017): 133,600
Long-Term Care Recipients At Home (2017): 252,310

Source: Organization for Economic Cooperation and Development. OECD.Stat. Last accessed Nov. 17, 2020.
https://stats.oecd.org/Index.aspx?ThemeTreeId=9#

“Concerns have recently grown about the quality of care in nursing homes. In 2016, the health inspectorate published a list of 150 nursing homes where quality of care was deemed insufficient. In the same year, a civil initiative to promote the quality of nursing home care was endorsed by parliament, which among other demands stated there should be at least two care providers per eight residents. The National Healthcare Institute (NHI) was commissioned to develop a quality framework that defined new standards with regard to attention for patients, attendance, supervision and competences. The NHI is by law authorised to define good care quality, and the government is obliged to provide the financial means to provide care according to these standards. The new quality framework has significant consequences for the national health budget will increase the budget for nursing homes up to EUR 2.1 billion per year.”

Source: OECD/European Observatory on Health Systems and Policies (2019), The Netherlands: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.
https://www.oecd.org/health/netherlands-country-health-profile-2019-9ac45ee0-en.htm

“The 2015 long-term care reform (Box 1) aimed to contain spending in the sector by shifting care delivery from institutions to private homes, but at the same time fragmented the system further. The new arrangements could impede efficiency and lead to a lack of coordination and skimping on quality if different care purchasers active in long-term care delivered at home (regional care offices, municipalities and health insurers) do not align their purchasing policies, and instead try to push responsibility for patients in need of long-term care onto each other (Alders & Schut, 2019). Furthermore, individuals only qualify for institutional care when they need 24 hours supervision, resulting in people with a substantial care burden living at home, placing pressure on the informal care system. This suggests there are implicit incentives within the system that need to be monitored and better aligned if needed.”

“Access to residential care for those needing 24/7 supervision depends on an assessment by the Centre for Needs Assessment (CIZ). The CIZ has been commissioned by the government to carry out assessment for eligibility under the Long-term Care Act. Patients, their relatives or their healthcare providers can file a request with the CIZ for long-term care. The CIZ assesses the patient’s situation and decides what care is required. The CIZ sends this decision to a care office (Zorgkantoor). Patients have the option to receive care in a residential home or at their own home. Residential care is provided in nursing homes. In 2014 there were 450 organizations for residential care providing care in about 2000 residential homes. (It is not clear to what extent these homes provide care that is covered by the Long-term Care Act.) For care at home, there are two options. Patients may receive care in-kind via the Complete Package at Home option (Volledig Pakket Thuis) or they receive a personal budget and organize the care themselves. To avoid fraud, personal budgets are no longer (since 2015) paid directly to the patient, but the amount is deposited into the account of the Social Insurance Bank. The Social Insurance Bank pays the care provider after checking both the contract between patient and provider and the registration of hours worked. At the beginning of 2015 this led to administrative chaos, as the Social Insurance Bank was not ready for this task and payments for numerous care providers ran overdue. By the end of 2015 the situation seems to have stabilized.”

Source: Kroneman M, Boerma W, van den Berg M, Groenewegen P, de Jong J, van Ginneken E (2016). The Netherlands: health system review. Health Systems in Transition, 2016; 18(2):1–239.
https://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits
https://www.euro.who.int/en/about-us/partners/observatory/publications/health-system-reviews-hits/full-list-of-country-hits/netherlands-hit-2016

“For long-term care at home for patients who do not need 24-hour supervision, nursing care needs are assessed and coordinated by district nurses. The care is provided by home care organizations, by district nurses (wijkverpleegkundigen) and by care assistants (verzorgenden). This type of care is now (since 2015) covered by the Health Insurance Act. In 2014 about 3.7% of the population aged 18 and over received some form of home nursing care. This includes sheltered housing, support in social participation, support for informal carers and support for clients to organize their life. Responsibility for these types of care were shifted to the municipalities in 2015 (Statistics Netherlands, 2015a).”

“Domestic care and social support are provided by home care organizations. Social support means that people with a (mental or physical) disability receive help in participating in society and in organizing their lives, if necessary, as well as the provision of medical aids (for example, wheelchairs) and home adjustments. According to the Social Support Act, people should be compensated for their inability to participate in society. Eligibility for domestic care and social support is assessed by the municipality; the municipalities usually operate a (virtual) Wmo-window where applications can be made. Assessment of needs for domestic care and social support is the responsibility of the municipalities and is mostly carried out by employees of the municipality or by social district teams. These assessments (frequently called “kitchen table dialogue”, keukentafelgesprek) first explore the options for support from the patients’ social network. If this appears to be insufficient, professional care may be deployed. This responsibility is formalized in the Social Support Act.

“In some cases municipalities delegate these assessments to the CIZ. Many municipalities have created social district teams that should flag up problems and help citizens with solving their problems with the help of their informal network. These social district teams mostly have a multidisciplinary character and coordinate the social support for citizens in their neighbourhood. Van Arum & Lub (2014) concluded that although the tasks of these teams are described in rather general terms, at the same time municipalities have formulated high expectations of the results of these teams: the teams are seen as the ultimate solution to social problems, especially in deprived neighbourhoods (van Arum & Lub, 2014).”

“In 2012 approximately 1.5 million people (12% of the population) provided informal care to ill or disabled people. Informal care is defined as providing care for eight or more hours per week or for more than three months to sick or disabled persons. Women (15% of women) provide informal care more often than men (9% of men). One in seven informal care providers feels overburdened (Centraal Bureau voor de Statistiek, 2013). Frequent forms of informal care are emotional support, household chores, accompanying patients during visits to family or care providers, help with administration and so on. Most informal carers provide care over a long period; 75% provided care for more than three months in a year, and on average for more than five years. The average informal carer spends about 22 hours a week on caring (de Boer, Broese van Groenou & Timmermans, 2009).

“In recent years (in the 2010s) Dutch health policy has been advocating a more central role for informal carers in caring for the sick and disabled. Dutch citizens, who consider long-term care the responsibility of the government, indicate that they are willing to provide care, but it should remain voluntary rather than obligatory (Kooiker & Hoeymans, 2014). Although the government acknowledges the importance of informal carers, financial compensation and facilities are limited. Informal carers may apply for respite care, but this may be subject to income-dependent co-payments. It is possible to insure respite care via VHI. Furthermore, there used to be a small yearly allowance, with a maximum of €250, called the “mantelzorgcompliment”. This nationally regulated amount was abolished in 2015, but some municipalities still provide this option. A tax reduction is possible for travel costs to sick family members. Support for informal carers, such as counselling or help in organizing care, is the responsibility of municipalities.”

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated Nov. 17, 2020 by Doug McVay, Editor.