Legislation relating to the provision of home care services
The new Health Insurance Act which came into force on 1 January 2006 abolished the former distinction between private and public health insurance. The act made it compulsory for every person residing or paying tax in the Netherlands to take out a health insurance. Every healthcare insurance company in the Netherlands, having agreed to provide services under the new Act, is obliged to accept any person who applies for insurance. People pay a nominal premium directly to the health insurer as well as an income-related contribution. The latter is levied by the Inland Revenue Service.
Under the Health Care Insurance Act, which also came into force on 1 January 2006, people may receive an allowance if the nominal premium is particularly high in relation to their income.
The Exceptional Medical Expenses Act of 14 December 1967 (implemented on 1 January 1968) – AWBZ – covers costs for the care of long-term chronic illness that are not covered by the Health Insurance Act. A basic principle of the AWBZ is that people should be helped to live at home for as long as possible. The AWBZ originally covered costly long term institutional care but the scope of the act was extended to cover other services such as home nursing in 1980 and home help in 1989. Health insurance companies are designated by the Ministry of Health, Welfare and Sport to implement the AWBZ.
Organisation and financing of home care services
Care provided under the Health Insurance Act and the AWBZ is divided into “products”. Home care and residential/nursing care for people with physical and/or mental disabilities are considered Medical Expenses Act products. A product consists of one or more functionally defined categories of care. There are seven broadly-defined categories of care:
- Domestic help
- Personal care
- Supportive guidance (e.g. help organising one’s daily life, day care etc.)
- Activating guidance (helping the person to adapt their behaviour or learn new skills)
- Treatment (care linked to a health condition e.g. rehabilitation after a stroke)
- Accommodation (e.g. sheltered housing, constant supervision, institutionalisation)
AWBZ is funded through a compulsory premium, a co-payment and general taxation. The compulsory premium is integrated into the income tax structure but it is the employer who pays the largest share. The amount of the co-payment depends on the type of service, the income of the person who needs it, whether they are over 65, whether they live at home or in an institution and whether they live alone or cohabit. There is, however, a maximum weekly co-payment for all forms of home care.
To be considered eligible for care, it is necessary to be assessed by an organisation called CIZ (Centrum indicatiestelling zorg). CIZ determines how much and what kind of care a person is entitled to receive. Once a person’s entitlement has been established, the person is free to choose care in kind, a personal care budget or a combination of the two.
Care in kind means care services provided directly by a health care provider. This is arranged in consultation with the client who can use one or more care providers. A personal care budget is an amount of money granted to the client to purchase care independently. The client is free to purchase the care services from a health care provider but also from any person willing to provide the service e.g. a friend, relative or neighbour etc. Clients receiving a personal care budget are obliged to provide regular justification of their expenditure. The personal care budget is quite popular. The number of people with a personal care budget increased from 5,400 in 1996 to 65,000 in 2003 (Beukeman quoted in van Vliet and Oudenampsen, 2004).
For care in kind, people may receive a bill or have the co-payment deducted from other state allowances. Co-payments for people receiving a personal care budget are deducted from the total amount that the person would otherwise receive.
Kinds of home care services available
Home care services are organised around the afore-mentioned categories of care. Examples include: home nursing (e.g. giving advice on how to cope with an illness, dressing wounds, administering medication), personal care (e.g. assistance with dressing, bathing, personal hygiene, eating and drinking), home help and housekeeping (e.g. cleaning, tidying and preparing meals), day care, respite care, night care and assistive devices.
A special service called “Alpha Care” consists of home care that is provided by housewives. It is less expensive but limited to 16 hours per week. Nursing care is limited to 3 hours per day except in exceptional circumstances (Brodsky et al. 2000).
Possible future developments
A Social Support Act is currently being debated. If passed, it is likely to absorb cover for domestic help, supportive care and activating care, currently provided under the AWBZ, as well as certain grant schemes under the AWBZ concerning support to elderly people requiring assistance from relatives and friends outside the professional setting. According to van Vliet and Oudenampsen (2004), the consequences of the possible future transfer of cover for certain services to the Social Support Act is that these services will become the responsibility of the local government and will no longer be part of the services that budget-holders can purchase themselves.
- Brodsky, J., Habib, J. and Mizrahi, I. (2000), A review of long-term care laws in five developed countries, http://www.wu-wien.ac.at/wwwu/institute/Sozialpolitik/LTC.pdf#search='A%20review%20of%20longterm%20care%20laws
- Ministry for Health, Welfare and Sport (2005), Health insurance in the Netherlands; the new health insurance system from 2006: http://www.minvws.nl/images/health-insurance-in-nl_tcm11-74566.pdf
- Van Vliet, K. and Oudenampsen, D. (2004), Integrated care in the Netherlands, http://www.verwey-jonker.nl/images/dynamisch/D3551878.pdf
- Visser-Jansen, G. and Knipscheer, C.P.M. (2004), National Background Report for the Netherlands, EUROFAMCARE: http://www.uke.uni-hamburg.de/extern/eurofamcare/documents/nabare_netherlands_rc1_a4.pdf
Last Updated: mercredi 15 juillet 2009