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Budget for decentralisaion of youth care

Report | 18-06-2013

Check of the calculation

The central government and municipalities want to position government tasks closer to the public. The government and the Association of Netherlands Municipalities (VNG) reached agreement in the Administrative Agreement 2011-2015 in May 2011 on, among other things, the decentralisation of youth care. Municipalities will now be responsible for the provision of all care for children, young people and the responsible adults. It was also agreed that central government – the Ministry of Health, Welfare and Sport (VWS) – would contribute the funds the municipalities need to carry out these tasks as a decentralisation payment to the Municipalities Fund. The ministry will determine how much it contributes on the basis of a series of algorithms included in the Administrative Agreement. The government and the VNG agreed that they would ask an independent body to check whether the algorithms had been applied correctly. On behalf of the State Secretary for Security and Justice (V&J) and the VNG, the State Secretary for VWS asked the Court of Audit to carry out the check on 27 March 2013. The Court of Audit accepted the request on 9 April 2013.

Conclusion

The Ministry of VWS has made a good start with the current calculation to determine the macrobudget for youth care. The May 2013 Circular states that the calculation of the macrobudget is provisional and may be changed in response to future decisions. Furthermore, the amount inevitably contains uncertainties due to the assumptions made, as reliable data are not yet available in some areas. In the Court of Audit's opinion, the ministry has made the best possible calculation in the circumstances.

Application of the algorithms

We concluded that the Ministry of VWS had calculated the payment in accordance with the algorithms included in the Administrative Agreement 2011-2015, with the exception of the following points:

  1. The ministry departed from the algorithms in a number of areas. It adequately justified its decisions with the exception of the proposed reduction in anticipation of the cut in youth care-plus capacity as from 1 January 2015, the anticipated growth in the volume of mental health care between 2012 and 2015 and the proposed reduction on account of the transport measure funded under the Exceptional Medical Expenses Act.
  2. The ministry has not yet completed its calculation. There is therefore some uncertainty regarding the size of the ultimate payment.
  3. The ministry's calculation took account of future decisions in response to, for example, the Rutte/Asscher coalition agreement, the reform of long-term care and the Care Agreement. This led to a number of departures from the algorithms.

Recommendations

The Ministry of VWS expects better data for 2012 on the Exceptional Medical Expenses Act and on curative youth mental health care currently funded under the Healthcare Insurance Act to become available in early 2014. Fewer assumptions will then be made to calculate the definite amount. We recommend that the State Secretary for VWS go to the greatest possible lengths to ensure that better data are available in early 2014. By better data we mean, firstly, up-to-date information (actual instead of provisional expenditure) and, secondly, more detailed information on the number of young people. We also recommend that the State Secretary for VWS recalculate the entire macrobudget on the basis of these better data.

Responses

On behalf of his counterpart at the Ministry of V&J, the State Secretary for VWS expressed his appreciation of the Court of Audit's enthusiastic response to the request. He was pleased with our conclusion that a good start had been made with the calculation of the macrobudget. The Court's finding that the amount inevitably contained uncertainties on account of the assumptions made where reliable data were not available was correct, thought the state secretary.

The check has enabled the State Secretary for VWS to give the municipalities a good and timely indication of the budget they will receive for their new tasks in 2015. He intends to inform the municipalities of the definite amount for 2015 in the May 2014 Circular. It is highly likely that the budget will differ from the one presented in the May 2013 Circular as certain policy decisions still have to be taken.