Barend van Lieshout sees big health care changes on the horizon. The Dutch will have to get used to care in the community.

After five weeks of deliberations, Rutte and Samsom presented their new government accord. At first glance the effect on spending power doesn’t seem too great. The same isn’t true for long-term care: the impact of the reforms will be huge. We are entering uncharted territory and only time will tell if the Dutch can get used to the changes.

The fascinating thing about the effect on spending power forecast by the CPB is that they are so slight you might almost think the budget deficit is quietly being taken care of. Part of those billions are being freed up in care, however, which, the CPB says, we will be using less of and so spending less on. 

Faculties

It is long-term care which will provide a hefty sum with the abolition of care packages 1,2,3 (by 2013) and 4 (in 2016) for the elderly, disabled and people with mental heath issues. The elderly person who would currently qualify for care package 4 is ‘no longer able to function independently in society’, ‘has a limited use of faculties like reasoning and memory, orientation and concentration’ and is unable to move about outside the home unaided. He or she will no longer qualify for a place in a home.

This will change our image of the elderly. They will remain at home for longer, supported by home care services far beyond the point at which we usually say: this really can’t go on any longer.

The economic institute for the building sector, which joyfully announced a building boom in the care sector, will have to go back to the drawing board. The number of places in care homes is set to go down in the next ten years. This will hit long-term care institutions very hard. Hospitals have been making the change to the decentralisation of services for the last ten years but care homes are going to lose 60,000 of their 145,000 places in only a few years. Fortunately, these are years we can use to reorganise home care services.

Decentralisation

The hospitals are continuing the trend towards decentralisation. Most hospitals still offer quite a comprehensive care package but the government is insisting on further specialisation. From university hospitals to small clinics: services will change. So far hospitals (and insurers) have not been very good at making choices in this matter. Making choices proves fatal for administrators, causes fights between doctors’ partnerships and, more often then not, ends up before a judge.

This accord increases support for insurers but that doesn’t mean they will be able to reform the hospital landscape this time around. Not that it will make much of a difference financially: the costs have been capped and now the sector is left to its own devices.

The forced cooperation between GPs’ weekend services and the hospital casualty departments is an interesting one. There are examples of successful partnerships but most doctors’ surgeries and casualty departments seems to exist in a permanent state of cease-fire. The problem is authority (who’s boss in casualty), the vision on care ( is a patient healthy until proven otherwise, or only when all ailments have been ruled out) and, of course, money (who gets the fee and who gets the referred patients).

People who are breathing a sigh of relief because their pay slip shows no significant change will find that limiting the budget deficit has a price. That pay slip is supported by the ability of society to care for the elderly, disabled and psychiatric patients in their homes. It’s not impossible. Other countries have done it for years. But that doesn’t mean we won’t have to get used to looking after our neighbours and relatives more than we have until now.

 Barend van Lieshout is a care adviser at Rebel