Integration and efficiency in complex and long-term care

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Integration and efficiency in complex and
long-term care ..

• Prof. Dr. Guus Schrijvers
• Denmark, januari 2010

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I want to present to you

• We carried out a preliminary study on the
  accessibility, care allocation, and assessment of
  long term care in seven European countries.
• What are the themes in the public debate in
  those countries, we asked ourselves en what can
  we learn from their practices?
• In this presentation I present to you some
  observations with the emphasis on the financial
  sustainability of the LTC.

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Development of the systems.

• 50 years ago, long term care was everywhere
  generally a private responsibility. A
  responsibility of the family, the local community
  and as a matter of last resort, of charity.
• Long term care is now everywhere, direct or
  indirect a mayor public responsibility.
• They are the product of the political en social
  history of the seven countries.
• In the Netherlands from 0 in 1945 tot 3.4
  of BNP in 2008.

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AWBZ of GNP
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Themes in the countries surveyed.
1) The financial sustainability of long term care.
2 How to integrate care, social participation and welfare.
3) Strengthening of the autonomy and empowerment people in need for longtime care.
4) Accessibility of care, care assessment and care providing.
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Accessibility of care, care assessment and care
providing.

• In all of the seven countries the accessibility
  to LTC is an important theme in the public
  debate.
• We see a tendency to introduce elements of a
  demand driven system in all seven countries.

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Accessibility of care, care assessment and care
providing.
Access to information Bureau- cracy Distri -bution Waiting lists Quality control Multiple counters No legally defined rights Postcode problem
Netherlands v v v v
France v v v v
England v v v v v v v v
Sweden v v v v
Switzerland v v v v v v
Belgium v v v v v v v
Germany v v v v v v
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Accessibility of care, care assessment and care
providing.
Supply driven Demand driven
Limitations Available care supply Available individual budget
Assessment criteria Urgency and risk Insurance or budget claim
Legal position Dependent of civil servants. Legally defined rights and written procedures
Assessment methods Professional discretion. Algorithms, based on legally defined rights
Responsibility Primarily public Primarily private
Care supply Public funding Effective demand

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Strengthening of the autonomy and empowerment.

• In all countries we see initiatives and debates
  aimed to empower the position and strengthen the
  autonomy of people in need of LTC.
• We see the public function gradually changing
  from a supply orientated and care providing role
  to a more supporting role, whereby people are
  enabled and supported to solve their problems in
  their own way and to their own preferences.

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Strengthening of the autonomy and empowerment.
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Growths of positive care assessments in the
Netherlands. Bron CIZ trendrapportages 2008
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Number of positive assessments.

• Relative increase 2005-2008
• Total 33
• supplies standard care 28
• personal budget 116
• SSC PB 112

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How to integrate care, social participation and
welfare.
Chronisch zieke moet kunnen meedoen Door in te
zetten op een ketenzorg voor chronisch zieken
streeft het kabinet naar winst voor individu en
arbeidsmarkt, schrijven de ministers Piet Hein
Donner en Ab Klink.
Now there are 4.5 million people with
chronically diseases, in 15 year 30 more
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How to integrate care, social participation and
welfare.
Integration promoting developments
Demand driven systems and initiatives.
Integrated Personal Budgets (France, England, Germany).
Diagnoses Related Groups DRG (Netherlands and Germany ).
Integrated assessment and Integrated decision making. (Switzerland en France, pilots in England, Belgium and the Netherlands).
Integrating budgets is one integrated budget. (France CNSA).
Case management, personal assistant, (Sweden, Belgium, pilot Netherlands).
All initiatives are limited to people under the age of 60, with a handicap or chronic disease.
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The financial sustainability of long-term care.
Financing long term care is expected to be a
growing problem in all these countries, causes
including
A decreasing proportion of the population, has to meet the rising costs of an aging population.
Productivity growth in care lags behind other sectors.
The level of expectation of care quality rises with the general welfare level.
One cannot rely on family support and informal care anymore.
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The financial sustainability of long term care.
Solutions to the financing problems

Increasing threshold levels (England, Sweden, Netherlands).
Diverting the cost to the local government by inflating the national or insurance contribution to the local government (Sweden, England, Switzerland, Netherlands).
Reduction (of growth of) care supply. (Sweden, England, Switzerland, Sweden, Belgium).
Increasing the costs of the people in need of care by raising the private contribution or inflating the public contribution (Switzerland, France, Germany).
Reducing the claim rights (Netherlands, Sweden)
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The financial sustainability of long-term care.
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Development of a three tier system.

• People in need of care (and/or their social
  environment) organize and finance their own care.
  
• People receive forfeiture means, like allowances,
  tax reductions, insurance means in order to keep
  their lives going tot their own preferences.
• for some people this will not be
  sufficient therefore
• They make a plan of their future with element as
  education, work, transport, income and care and
  they receive a integrated budget, with enables
  them to carry out that plan. (France, pilots in
  Germany and England).

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A three tier system.
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I thank you for your attention!!
Guus Schrijvers
http//www.integratedcare.eu/integratedcare_ned/do
wnloads/090905laatste-30-juli.pdf