A Good Life in Old Age? Monitoring and Improving Quality in Long-Term Care

The Netherlands was the first amongst OECD countries to introduce compulsory Social Health Insurance for long-term care in 1968. Since 1994, it has been one of the few countries to advocate personal care budgets. Long-term care in the Netherlands has comprehensive coverage, the possibility to choose services in cash, and a high availability of home care services. Such comprehensive system is under stress to demonstrate high quality and value for money from high levels of spending. The Netherlands spends 3.7% of GDP on LTC, the highest of the OECD countries. The growth in public expenditure on LTC has been above 10% in real term during 2000-10. Projections suggest that expenditure might at least double by 2050. Nearly 13% of population aged 65 and over receives care at home, compared with the OECD average of 4.9%. However, the number of care workers in home care was only 14 per 1 000 people aged 65, relative to a ratio for workers in institutions of 63 LTC workers per 1 000 people.