|Implemented in this survey?|
The Social Support Act (WMO) is meant to manage the integration of people with limitations in society. This new Law will make municipalities responsibility for home care, supporting and activating care, as well as the regulations for transport, client support and various subsidies.
Manage the integration of people with limitations in society
Both financial and non-financial
Persons with limitations and elderly, Municipalities, Care providers
|Medienpräsenz||sehr gering||sehr hoch|
The WMO is the result of emphasising individual responsibility in health care, both at the insurance side as well as the provision of care side. Within this concept, the current government
(Balkenende-II) is planning to establish a new basic health insurance scheme for the entire population. A new curative health care system will have to be developed (see the previous survey from the
Netherlands, in particular the new Health Insurance Act, "de Zorgverzekeringswet").
Simultaneously, the Exceptional Medical Expenses Act (AWBZ) will be modernised and 'stripped'. Specific services (long term and social care) will be transferred to the Social Support Act, the WMO and the the new Health Insurance Act.
The WMO is part of the health insurance system reform and introduces a new scheme for all Dutch citizens covering care and support in cases of protracted illness, invalidity or geriatric diseases.
The increase in demand and the rising costs of the AWBZ necessitate this reform. In order to control the (long term) costs, the AWBZ will focus on the core benefits, i.e. highly expensive care, whereas the WMO will focus on care for the disabled, older citizens in need of care and psychiatric patients.
The relation between WMO and AWBZ is:
|Implemented in this survey?|
The revision of the AWBZ and introduction of the WMO has been initiated by the current government (Balkenende II). The government aims at three points:
The WMO is not a completely new approach. It is the result of the reform of the Exceptional Medical Expenses Act (AWBZ) which has been discussed earlier in other survey's.
Benchmarking requires transparency of provided services and indication of needs. This might be problematic to realise in practice.
A small scale example is the case study WMO in the city of Nijmegen to study potential consequences for civilians, the municipal board and the organisational structure.
The result was some criticism towards the WMO. Summarized these comments include:
A) Equality before the law will be questioned since each municipality is entitled to develop their own rules. This might result in a diversity of provided services by each city.
B) The period of implementation is too short. The introduction of the draft Law is expected only in Spring 2005, whereas is should come into force in January 2006.
C) Financial insecurity for local authorities. The government has indicated that the AWBZ is budgetary out of control. As a result of the WMO transfer, the danger will be shifted to local authorities.
|Minister of Health, Welfare and Sports||sehr unterstützend||stark dagegen|
|House of Representatives||sehr unterstützend||stark dagegen|
|Senate||sehr unterstützend||stark dagegen|
|Health providers||sehr unterstützend||stark dagegen|
|Health Insurance companies||sehr unterstützend||stark dagegen|
|Patients||sehr unterstützend||stark dagegen|
|Civil Society||sehr unterstützend||stark dagegen|
|Scientists||sehr unterstützend||stark dagegen|
Early 2005, The draft Law on Social Support (WMO) will be presented to Parliament.
So far, government papers outlines the general notion of the WMO. The WMO is part of the modernisation process of the Exceptional Medical Expenses Act. Combined with the Law on Services for the Disabled (WVG) and the Welfare Act, the WMO will be under auspicies of local authorisation.
In December 2004 a Public Consultation about the WMO will take place. This may result in changing the original policy paper.
The MoH is strongly depended on the support of the Board of local authorities (VNG) , which opposes certain aspects of the WMO. At this moment, the ministry is negotiating with the VNG to reach consensus.
|Minister of Health, Welfare and Sports||sehr groß||kein|
|House of Representatives||sehr groß||kein|
|Health providers||sehr groß||kein|
|Health Insurance companies||sehr groß||kein|
|Civil Society||sehr groß||kein|
Not applicable yet
With respect to decentralising the decision-making and provision of care it is likely that the idea will be realized, major responsibilities will be transferred to local governments.
Cost containment of the AWBZ: The transfer of services towards the WMO will decrease the costs of the AWBZ. However, one may doubt the decrease of costs since the AWBZ focuses on exceptional (and therefore expensive) care. This type of care is less controllable.
Experts have their doubts about the willingness and capacity of local governments to implement this Law.
The margin of discretion in decision-making on the type and scope of services may endanger equal access to these services. Access will also depend on the financial situation of the municipality.
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
Ministry of Health web page (www.minvws.nl) (all in Dutch)
Policy papers of the House of representatives of the States General (all in Dutch)
Search site www.google.nl references: WMO, maatschappelijke ondersteuning, langdurige zorg, AWBZ.
Anniek Peelen, Jos Holland and André den Exter