Reform of the Exceptional Medical Expenses Insurance Scheme

A simulation of the consequences

The Court of Audit has carried out a simulation to help prepare for the reform of long-term care. How will clients entitled to care under the Exceptional Medical Expenses Insurance scheme be cared for in the new regime? The simulation revealed the potential consequences of the reform of long-term care. Parliament needs this type of information to debate the reform of long-term care. The results of the simulation are presented in the report, Reform of the Exceptional Medical Expenses Insurance Scheme: a simulation of the consequences, which was published on 22 April 2014.


To give one example, 67,000 elderly people are currently entitled to residential care under the AWBZ. In the new system, future clients would receive this care at home. Under the transitional arrangements, clients receiving residential care in 2014 will continue to do so. The reform of long-term care was agreed in the Rutte-Asscher coalition agreement. Long-term care currently funded from the AWBZ will be funded from four schemes as from 2015, subject to parliamentary approval: the Care Insurance Act (ZVW), the Social Support Act (WMO), the Youth Care Act and the Long-Term Care Act (WLZ). Municipalities and care insurers will be given more responsibility in the new system. One of the government’s aims is to improve the quality of care. Furthermore, the cost of long-term care must be cut by €3.4 billion by 2017. Nearly 800,000 people were receiving long-term care under the AWBZ in 2012, at a cost of €27 billion. Our audit did not consider the recent Spring Agreement on care provision reached between the government and a number of political parties in the House of Representatives.


Provision of information

We recommend that the Minister of Health, Welfare and Sport (VWS) provide good information on a timely basis on the reform of long-term care provision. Information on the decentralisation of long-term care should be consistent with the information collected by the municipalities and other actors. It should also be consistent with the data and information provided on other large decentralisation operations in the social care sector.

We also recommend that the Minister of VWS use modern techniques to collect, analyse and publish the information. Linking the information to maps, for example, would improve insight into the local and national situation of vulnerable people. Providing information on an open data platform would also enable people to see for themselves how their local municipality is performing. An open data platform would also reveal where the new regime is and is not working.


Response of the State Secretary for VWS

The State Secretary thinks the recommendations include valuable suggestions that can be incorporated into the reform of long-term care. He appreciates the Court of Audit’s finding that the Information Management in Order Programme is a suitable starting point for the further organisation of the information and monitoring function.

The State Secretary makes two comments on our report. The first concerns the division of one domain into four domains. ‘The reforms are designed to strengthen the coherence of the various care domains for the benefit of the client, so that the client has to deal with fewer domains. It is important that, for example, the “social domain” (support at home) is more closely linked to primary care (the “medical domain”). This is not adequately recognised in the report.’

The second comment relates to the effect of providing outpatient care to 67,000 elderly clients. ‘This representation could suggest that these people will be forced to move home whereas only new clients will receive outpatient care and existing rights will not be affected. Furthermore, this trend began several years ago, with elderly people themselves deciding to receive outpatient care at home. As you rightly note, the Court of Audit was unable to take account of the recent Spring Agreement. As you will be aware, the Springs Agreement has important consequences for the figures on outpatient care.´

The close, the State Secretary pointed out shortcomings in our simulation. ´I have the following comments:

  • The figures relate to 2012. Developments in 2013 were not included in the simulation;
  • The report considers needs assessments and it is known that there is a significant difference between the assessment and the actual care people receive (volume, exercise of rights, delivery form, etc.);
  • The report looks forward to the long-term situation. On account of the transitional arrangements, more use will be made of the WLZ in the initial years than suggested by the report. It should be clear that it will take several years to reach the long-term situation;
  • The report takes no account of recent policy developments, such as the budget cap for mental health care and the Spring Agreement to limit the provision of outpatient care. As a result, the report´s allocation to domains in not correct in all cases.’

Court of Audit´s afterword

We read the State Secretary´s response to our report with interest. We have incorporated his factual comments into the report in so far as possible. We appreciate the State Secretary´s ambition to reform long-term care in order to strengthen the relationship between the various care domains. The reform will re-allocate duties, powers and budgets for long-term care and other support to the municipalities, care insurers and the government. The reform is laid down in four laws: WMO 2015, WLZ, ZVW and the Youth Care Act. We would stress that effective coordination among the parties concerned is a precondition for the required coherence in the care domain. As we noted in the report, we would again stress that we carried out a simulation to map out the potential consequences for future clients. This means that clients who are already entitled to residential care will retain their rights. The simulation was carried out in order to inform parliament’s debate of the WMO 2015 and WLZ.

The reform of the AWBZ is still subject to change The information and policy intentions referred to in the report relate to the situation in mid-March 2014 The report did not consider the results of the recent Spring Agreement on care provision reached between the government and a number of political parties in the House of Representatives. The scope of the simulation is therefore not affected.