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The Social Support Act (WMO)

Country: 
Netherlands
Partner Institute: 
Institute of Health Policy & Management, Erasmus University Rotterdam
Survey no: 
(4)2004
Author(s): 
Peelen, Anniek, Jos Holland and Andr den Exter
Health Policy Issues: 
Long term care, System Organisation/ Integration, Funding / Pooling
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? yes no yes yes yes no yes
Featured in half-yearly report: Health Policy Developments Issue 4

Abstract

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.

Purpose of health policy or idea

  • 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.
  • In other words, local authorities will have a leading role in implementing the new Law. They will develop local policy, responsible for financing and contracting of all WMO activities, establish one office for organising care, cure and welfare, for the indication of WMO services and for quality of care.
  • Care providers will be able to negotiate contracts with the municipality to formulate a proactive and community driven intervention program and by that providers will strengthen the relation with the client.

Main points

Main objectives

Manage the integration of people with limitations in society

Type of incentives

Both financial and non-financial

Groups affected

Persons with limitations and elderly, Municipalities, Care providers

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Characteristics of this policy

Degree of Innovation traditional neutral innovative
Degree of Controversy consensual neutral highly controversial
Structural or Systemic Impact marginal rather fundamental fundamental
Public Visibility very low low very high
Transferability strongly system-dependent neutral system-neutral

Political and economic background

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:

  • The WMO covers forms of social support that stimulate persons to stay longer at home, e.g. home care activities. It also covers welfare activities, home adjustments and information and advice. The Act on Services for the Disabled (WVG), the Welfare Act and parts of the current AWBZ will be transferred under the WMO. The municipalities will be responsible for the operation of the WMO.
  • The AWBZ will only cover highly expensive care which is difficult to insure.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? yes no yes yes yes no yes

Origins of health policy idea

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:

  1. People who have the possiblity will be forced to find solutions for individual problems themselves.
  2. Municipalities will be responsible to develop a coherent system for inhabitants who are not able to make their own decisions and find solutions for their problematic situation. It concerns housekeeping, social support, transport with a wheelchair, et cetera.
  3. The government will be responsible for the Exceptional Medical Expenses Act (AWBZ). This Law is ment for serious chronic patients and patients who need permanent, non-insurable care.

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.

Initiators of idea/main actors

  • Government
  • Parliament
  • Providers
  • Payers
  • Patients, Consumers
  • Civil Society
  • Scientific Community

Stakeholder positions

  • The health care advisory body (Board of Public Health Care, RVZ) suggested the government to limit the scope of the AWBZ and to transfer to the WMO
  • The association of municipalities (VNG) is opposed since they fear extra work without sufficient funding.
  • The Organization of Care for Disabled is concerned about the increased bureaucracy due to new established intake offices. The government considers this fear unfounded since the local intake offices function already
  • Health providers concern a loss of market share. This can be from 30 up to 60 percent since municipalities will contract selectively.
  • The Council of Chronic Patients and Disabled are fully opposed to all plans regarding the WMO. They fear the limitation of access to care. They fear the lack of funding of the services provided. The Council wants to relate the payment which municipalities receive, with the care or provisions which they distribute.

Actors and positions

Description of actors and their positions
Government
Minister of Health, Welfare and Sportsvery supportivevery supportive strongly opposed
Parliament
House of Representativesvery supportivesupportive strongly opposed
Senatevery supportivesupportive strongly opposed
Providers
Health providersvery supportiveopposed strongly opposed
Payers
Health Insurance companiesvery supportiveneutral strongly opposed
Patients, Consumers
Patientsvery supportiveopposed strongly opposed
Civil Society
Civil Societyvery supportiveopposed strongly opposed
Scientific Community
Scientistsvery supportiveneutral strongly opposed

Influences in policy making and legislation

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.

Legislative outcome

pending

Actors and influence

Description of actors and their influence

Government
Minister of Health, Welfare and Sportsvery strongvery strong none
Parliament
House of Representativesvery strongvery strong none
Senatevery strongstrong none
Providers
Health providersvery strongneutral none
Payers
Health Insurance companiesvery strongneutral none
Patients, Consumers
Patientsvery strongweak none
Civil Society
Civil Societyvery strongweak none
Scientific Community
Scientistsvery strongneutral none
Minister of Health, Welfare and SportsSenateHouse of RepresentativesHealth Insurance companies, ScientistsPatients, Civil SocietyHealth providers

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

  • Major stakeholders involved in the process towards implementation are the local authorities, its umbrella organization (the VNG), providers of care and patient organizations
  • Cooperation between municipalities, providers of care and clients is considered crucial in realizing the law's objectives
  • Guarantee sufficient funding can be considered as an incentive to the VNG's support
  • Postponement of enactment is also an option to applease opponents

Monitoring and evaluation

Not applicable yet

Expected outcome

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.

Impact of this policy

Quality of Health Care Services marginal rather fundamental fundamental
Level of Equity system less equitable two system more equitable
Cost Efficiency very low high very high

References

Sources of Information

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.

Author/s and/or contributors to this survey

Peelen, Anniek, Jos Holland and Andr den Exter

Suggested citation for this online article

Peelen, Anniek, Jos Holland and Andr den Exter. "The Social Support Act (WMO)". Health Policy Monitor, November 2004. Available at http://www.hpm.org/survey/nl/b4/1