Long-term care reforms in the Netherlands

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.