Macrobudgets for the Youth Act and Social Support Act 2015

Report | 13-05-2014

Conclusions

The calculation of the macrobudget contains fewer uncertainties than the calculation made in 2013. We concluded that it is difficult to calculate the expenditure on young people under the Exceptional Medical Expenses Act (AWBZ) and the Health Insurance Act (ZVW). The problem has been partially resolved by the Ministry of Health, Welfare and Sport’s use of new datasets that make fewer assumptions.

However, this does not mean that there are no longer any uncertainties about the aggregate amount. Although there have been improvements there are still some uncertainties in the calculation of the macrobudget for both the Youth Act and the Social Support Act 2015. On the one hand, these uncertainties are inherent in the calculations and there is no definitive answer to them. On the other, some of the remaining uncertainties could be resolved before the final macrobudgets for 2015 are set in the 2014 May Circular. 

In early 2014, the Ministry of Health, Welfare and Sport (VWS) based its calculation of how much will be transferred for the municipalities to implement the Youth Act and Social Support Act on a series of base years. For the AWBZ, the base year was 2013 and for the ZVW it was 2012. Budgeted expenditure for the Youth Act and the Social Support Act is based on the 2014 budget. In its calculation of expenditure for the AWBZ, the Ministry of VWS makes a distinction between care in kind and care funded from a personal budget.

A number of figures are not yet known to update the calculations from the base year to 2015. One of them is the salary and prices indexation for 2014, which the Ministry hopes to clarify in the 2014 May Circular. The size of this correction is not known. Furthermore, €173 million of the AWBZ expenditure has not been allocated for the Long-term Healthcare Act, the Social Support Act 2015 and the Youth Act. A substantial proportion (€115 million) relates to the Healthcare Infrastructure Regulation. The Ministry of VWS wishes to receive an advisory report from the Netherlands Healthcare Authority (NZA) before allocating these funds. There is also uncertainty about the €219 million budget the municipalities will receive for extramural care: more people will be treated at home instead of in a hospital. The update to 2015 also contains several other uncertainties.

Recommendations

Given the short time before the introduction of the Youth Act and the Social Support Act 2015, clarity on the macrobudgets is required. We recommend that before issuing the 2014 May Circular, the State Secretary for VWS and, regarding the Youth Act, the State Secretary for Security and Justice (V&J): 

• take a decision on salary and price indexation for 2014; 
• clarify the subsidiary budgets that have been named but whose size is still unknown or has not been set; 
• take a decision on the changes in the subsidiary budgets further to the study of the consequences of extramuralisation and the NZA’s advisory report on the Healthcare Infrastructure Regulation.   

We recommend that the State Secretary for VWS make timely agreements before the new macrobudgets are adopted on the increase in volume and also on salary and price indexation in 2015 and subsequent years. We recommend that the State Secretary for VWS include the effects of extramuralisation and the personal budget measures after 2015 in the new calculations.

Recommendations specifically for youth care

We audited the calculation of the macrobudget for 2015. One of the management agreements for youth care was that a structural budget of €90 million gross would be transferred from the Provinces Fund to the Municipalities Fund when youth care is transferred from the provinces to the municipalities in 2016. We did not audit this. The VNG has asked the State Secretary for VWS to transfer this budget by 1 January 2015 because youth care will be transferred in 2015 and not in 2016 (which the management agreements had assumed). We recommend that the State Secretary for VWS clarify the situation in the 2014 May Circular.

Response

Response of the Ministers and State Secretaries for VWS and V&J and the Board of VNG

The Ministers and State Secretaries for V&J and VWS expressed their appreciation of our audit and expected to increase certainty about the figures in May 2014. The Chairman of VNG’s Board also appreciated the audit and assumed that talks would be held on the uncertainties that the Court of Audit had concluded could still be resolved.

Court of Audit’s afterword

We would note that the response did not clarify how the unallocated amount of €173 million from the AWBZ would be allocated. Furthermore it is not clear whether the Ministry of VWS will transfer the €90 million from the Provinces Fund to the Municipalities Fund in 2015. The municipalities have asked it do so because youth care will be decentralised a year earlier than originally planned and therefore want the money to be transferred to the Municipalities Fund a year earlier. There are still points that the ministries and the VNG must resolve.