Personal budgets in the Netherlands

International Seminar on Social and Health systems in Europe organized by SITRA. Helsinki 7 – 8 September 2010.

Presentation by Floris de Boer (Direction Long term care).

Content

1.Introduction2.History3.Facts & figures4.Less satisfactory

developments5.Necessary

interventions to make the system future-proof

6.Upcoming developments

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I. Introduction

• An incident• Thanks & introduction• Content of the speech

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II. History

• 1991: “Working document innovation care for mentally disabled persons”. • 1995: “Care in your wallet”• Quango’s and politics

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III. Facts and figures

• Dutch peculiarities• Growth number budget holders and granted/available budget • Quality of care, made available by personal budgets

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(ZVW)cure

(AWBZ)

care

(WMO)Social support

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There is a whole world outside the long term care……

• PGB in the long term care• PGB in the Social Support Act (Wmo) for domestic home help, transport, wheelchairs, adjustment of house (for disabled people)• PGB for re-integration (finding a job after a period of inability to work)• PGB for (medical) aids such as hearing aids etc.• PGB for the cost of psychiatric treatment (cure)

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Year 2003 2004 2005 2006 2007 2008[1] 2009[2]

Number of budget holders

62.500 69.500 80.500 95.000 90.000[3] 110.000 130.000

Average increase pro month

1.042 583 917 1.208 2.000 1.700 1.700

Expenses in million Euro’s

635 764 922 1.136 1.455 1.846 2.220

[1] Ramingen[2] Ramingen[3] Zonder de Wmo zouden er circa 30.000 budgethouders meer zijn

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aantal pgb-houders

60000

70000

80000

90000

100000

110000

120000

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Way of supply

Target groups Care in kind Personal budgets

Both

Demented elderly people Elderly people with somatic disordersDisabled peoplePeople with psychiatric disorders

70.000 295.000 85.000 50.000

1.000 19.000 19.000 32.000

1.000 5.000 9.000 2.000

Total 500.000 71.000 18.000

Bronnen: bewerking op basis van gegevens zzp-bronbestand, NZA, CAK, CIZ en CVZ en VGZ.

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IV. Less satisfactory developments

• Intermediary agencies• Fraud • Inappropriate use: personal budgets as an unintentional choice

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V. Necessary interventions to make the system future-proof

• Re-thinking target groups• Temporary stop growth, expansion, personal budgets second half 2010

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AWBZ in historic perspective

1968 1998 2008

CostsAWBZ-care1 (billion €’s)

< € 1 € 12,8 € 20,5

Number of clients Circa 55.000 Circa 900.000Circa 500.000 (excl. GGZ-extramural)

Circa 600.000

Premium AWBZ 0,41 % 9,60% 12,15%

1Exclusief kosten voor beheer en subsidies AWBZ.

Bronnen: VWS-begroting

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VI. Upcoming developments

• Reduction of target groups• Person budget ideology will influence regular “care-in-kind”• Personal remarks