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Standardized average health expenditure with two projections, isolating the reallocation effect (red line) and the effect of the changes in average expenditure per step (green line) (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article).
Source publication
Aging populations add to pressure on health budgets, notably in long-term care (LTC). This development is particularly significant in the Netherlands, because of its relatively large, publicly financed LTC sector. The recent LTC reform aimed to substitute institutional care with aging-in-place, and thus reduce LTC expenditure. We investigate whethe...
Contexts in source publication
Context 1
... shown in Fig. 3, the reform to LTC was accompanied by a slowdown in thehealth expenditure on those aged 65 years and over. We observe a decrease of over 4 % in average health expenditure on this group in the post-reform period 2015-2016. The standard- ized average expenditure per life-year (the bar chart in Fig. 3) was just over D 8,800 in 2012 and ...
Context 2
... shown in Fig. 3, the reform to LTC was accompanied by a slowdown in thehealth expenditure on those aged 65 years and over. We observe a decrease of over 4 % in average health expenditure on this group in the post-reform period 2015-2016. The standard- ized average expenditure per life-year (the bar chart in Fig. 3) was just over D 8,800 in 2012 and grew by 1.6 % in 2013. This trend was reversed from 2014 onwards, starting with a decline of nearly 1 % in 2014, and followed by a drop of more than 5 % in 2015. The year 2013 corresponds with the point when the first restrictions on institutionalized care were implemented, while the drop in ...
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Citations
... (1) Demographic factors [16][17][18]; (2) Non-medical health determinants [19,20]; (3) Societal characteristic factors [21,22]; (4) Medical technological advancements [23,24]; (5) Environmental pollution factors [25][26][27]; and (6) Other macroeconomic elements [28,29]. Based on existing research, non-income factors play an important role in influencing health expenditures, with this study primarily focusing on ecological environmental quality factors. ...
... 64,65 By 2040 there will be 700,000 more lonely people over the age of 75 in the Netherlands. 66 These and other issues make social inclusion and cultural participation critical issues in the social domain. ...
Arts in health is the field that advances the use of artistic practices for health and well-being, to stimulate a positive approach to health. While arts in health fields have been successfully established in other countries, the Dutch field is still fragmented, and its potential has not been fully developed. This white paper is an intersectoral effort exploring the current state of arts in health in the Netherlands. The authors strongly believe that arts in health can help navigate challenges faced by our healthcare system in the coming decades, and we have formulated an agenda to establish a sustainable Dutch arts in health field.
... 64,65 By 2040 there will be 700,000 more lonely people over the age of 75 in the Netherlands. 66 These and other issues make social inclusion and cultural participation critical issues in the social domain. ...
Arts in health is the field that advances the use of artistic practices for health and well-being, to stimulate a positive approach to health. While arts in health fields have been successfully established in other countries, the Dutch field is still fragmented, and its potential has not been fully developed. This white paper is an intersectoral effort exploring the current state of arts in health in the Netherlands. The authors strongly believe that arts in health can help navigate challenges faced by our healthcare system in the coming decades, and we have formulated an agenda to establish a sustainable Dutch arts in health field.
... For example, multiple hospitals filed for bankruptcy in 2018 due to quality and quantity of care issues [55]. The introduction of market principles to the health insurance sector as well as the decentralization and reallocation of the long-term care (accompanied with large budget cuts), have contributed to slowdown the growth of the total health expenditure [21,56]. However, it remains to be seen the coming decades if these efforts for cost-containment are sustainable as the population continues to age [21,36]. ...
Universal health coverage, as one of the targets of the Sustainable Development Goals, is the access to key promotive, preventive, curative and rehabilitative health interventions for all at an affordable cost. It is a practical expression of the concern for health equity and the right to health, and a goal for all countries. This review is a novel attempt to explore the healthcare provision in the Netherlands as an expression of universal health coverage based on the right to health.
The study adopted a narrative review approach using a framework that consists of 10 universal health coverage indicators which are derived from seven human rights principles. The techno-economic approach to healthcare provision by the Dutch state achieves a healthcare system where most of the population is covered for most of the services for most of the costs. The Dutch state complies with its minimum core obligations, while less attention is paid to participatory decision making and non-discrimination principles. However, with the fiscal sustainability of healthcare provision showing erosion, basing healthcare policy on values based on human rights principles might prevent a regressive policy.
... The former comprehensive public LTC insurance scheme (AWBZ) had generated a system characterized by a relatively high use of formal and institutional care, resulting in the highest public LTC expenditure as percentage of GDP worldwide (3.7 percent in 2017) [1] . This scheme was replaced by a less comprehensive one (Wlz) covering only institutional care and intensive home health care (as a substitute for nursing home care) [2][3][4] . The other benefits formerly covered by public long-term care insurance (LTCi) were transferred to municipalities and health insurers. ...
With the reform in 2015 of the system of long-term care (LTC) in the Netherlands, responsibilities for the provision of social support and assistance were delegated from the central government to the municipalities. Unintentionally, the way municipalities are financed created incentives to shift cost from the local level back to central level. In this paper we examine whether municipalities respond to the prevailing financial incentives by shifting costs to the public LTC insurance scheme. Using data on almost all Dutch municipalities over the period 2015-2019, we estimate that municipalities with a solvency rate below 20% have a 2.5% higher admission rate to the public LTC scheme. Furthermore, we show that the tightening municipal budgets for social care since 2017 were accompanied with about 14% higher admission rates in 2018 and 2019 compared to 2015. The results point to strategic cost shifting by municipalities that can be counteracted by changing the financial incentives for municipalities and by reducing the existing overlap between the local and central care domains.
... The ability of the EU to address the triple challenge is hampered by a potential shortage of care professionals projected in the near future (European Commission, 2012;OECD, 2020). Therefore, all EU Member States have adopted policies to encourage home-based care and thus, "ageing in place" in order to reduce utilization of institutional LTC (Krabbe-Alkemade et al., 2020;Plöthner et al., 2019). Nonetheless, the ability of older adults to stay at home with age-related declines in capabilities may be compromised by the absence of viable caregiving options. ...
... According to Spasova et al. (2018), the high incidence and expansion of informal care are mainly attributable to the lack of accessible institutional LTC options, as well as the traditional model of intergenerational and familial relations that promotes extended periods of family caregiving before institutional placement takes place. In addition, a number of countries are increasingly moving away from institutional to home-and community-based care provided formally or informally by family and/or friends (Krabbe-Alkemade et al., 2020;Lehnert et al., 2019). This rebalancing of LTC provision stems from austerity measures intended to reduce the reliance on more expensive institutional LTC options, as well as individual's preferences for receiving care at home (Lehnert et al., 2019;Simonazzi, 2008). ...
... Encouraging greater provision of home and communitybased services can be a way to contain costs, mainly due to the fact that in some cases, providing care in institutions is more costly than providing care in the community (Simonazzi, 2008). However, it is not known to what extent and under what conditions home care is less expensive (Krabbe-Alkemade et al., 2020). ...
Cost containment and the preferences of older adults are important stimuli for encouraging the provision of informal care worldwide. Nevertheless, informal caregiving can have negative effects on caregiver’s health, wellbeing, and employment opportunities. Moreover, it is questionable whether informal caregivers can substantially contribute to meeting the increasing demand for care or serve as a substitute for formally provided services. This commentary assesses strategies to remediate the negative effects of caregiving and ultimately to improve informal caregiving and to support their critical role in European long-term care systems. Cash benefits are a particularly common method of supporting informal caregivers; paid and unpaid leave, and flexible work arrangements are the most prevalent measures to support family caregivers within labor market policy, specifically. Providing training and counseling services to individuals engaged in informal care is a strategy used to support caregivers at home. Disparities in the level of support provided to informal caregivers across the European Union need to be addressed. A lack of supporting policies increases the likelihood that caregivers experience negative physical and psychosocial health problems, as well as unemployment and impoverishment.
... In recent years there has been a steady increase in healthcare expenditure. There is also an increase in life expectancy, which has a significant impact on health spending (Krabbe-Alkemade et al. 2020;Frączkiewicz-Wronka et al. 2019). The health harm from pollution (air, water, etc.) leads to increased healthcare expenditures (Apergis et al. 2020;Giannakis et al. 2019;Cincinelli and Martellini 2017;Szemik et al. 2019). ...
