Abstract
The foundation of the current Dutch long-term care system dates back to the end of the 1960s, when a compulsory social insurance to cover the costs of “exceptional medical expenses” (AWBZ) was introduced. Since then, the system has undergone a continuous process of reform. This chapter first reconstructs the original logic of the system through a historical and institutional analysis. The trends toward reform are then considered, looking at how the problem of change has been constructed and at the actors playing a relevant role in this process. Over the last decades, different logics have been adopted in the innovation of the system, ranging from the redefinition of eligibility criteria and resource allocation (deinstitutionalization of the service provision system and restrictions in access) to changes introduced in the governance of long-term care (users’ empowerment), to the redefinition of the boundaries of the system as such (the separation of care from household assistance and the shift of psychiatric cases to the healthcare system). All these aspects are described and critically reviewed in order to understand the directions and impacts of institutional change.
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- 1.
The “Homes for the Elderly Act” (WBO) of 1963 established national regulations for care homes for older people.
- 2.
The employer withholds the employees’ contributions from their wages and pays them to the tax authorities. Nonemployees liable for tax and national insurance contributions pay the AWBZ contribution based on an assessment made by the tax authorities. Insured people under the age of fifteen, and above fifteen with no personal income, are not liable to pay contributions.
- 3.
There is only one exception allowed regarding this rule for equal premiums for all under the same insurer: the case of collective insurance by employers for all their employees. The reduction, however, cannot exceed 10 %.
- 4.
In 2007 840,214 people received AWBZ-financed care. 653,300 were aged 65 and above, 490,130 of which received extramural care (CBS 2008: 122–123)
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Da Roit, B. (2013). Long-Term Care Reforms in the Netherlands. In: Ranci, C., Pavolini, E. (eds) Reforms in Long-Term Care Policies in Europe. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4502-9_5
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