Rene van Kujik NHPRC 2013

From welfare state to participatory society

Lessons from The Netherlands 7th Nordic Research Conference in Health Promotion June 2013

www.pwc.nl

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Outline

1. Population ageing

2. Population ageing in The Netherlands

3. Pressure on the welfare state

4. From welfare state to participatory society

5. Lessons from the daily practice

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June 2013 From welfare state to participatory society

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1. Population ageing Some global trends Population ageing is a worldwide phenomenon, caused by:

• Decrease in fertility

• Decrease in mortality rates

• Higher life expectancy

• Some Western European countries (and the US) faced a rapid temporary increase of birth rates shortly after WW2: The Babyboom

Furthermore we see trends such as

• Urbanization

• Digitalization

• Individualization

• …


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1. Population ageing Old age dependency ratio in Europe in 2010


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10-20%

20-30%

30-40%

40-50%

50-60%

60-70%

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1. Population ageing Old age dependency ratio in Europe in 2060


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10-20%

20-30%

30-40%

40-50%

50-60%

60-70%

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2. Population ageing in The Netherlands Projections

• Strong increase of number and proportion of elderly in the Dutch society

• Number and proportion of children is stabile

…and that is relevant because?


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0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

0

2

4

6

8

10

12

14

16

18

X m

ln

0-20 20-64 65+

Old age Young age

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2. Population ageing in The Netherlands Characteristics of ‘the group’ elderly

• ‘The elderly’ are a fast growing group, but also a extremely heterogeneous group


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2. Population ageing in The Netherlands Characteristics of ‘the group’ elderly

In The Netherlands there are currently about 2,6 million people over 65:


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One out of five persons in The Netherlands is retired

In 2010 there were 3 million households of elderly

800.000 elderly feel lonely

25% are at risk of health problems, moving to a nursing home or decease

150.000 live in a nursing home

Elderly have a higher risk of life changing events

The demand for healthcare will increase with 34% from 2006 to 2030

De demand for stay in a nursing home will increase with 40% and for home care with 32%

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2. Population ageing in The Netherlands Semantic intermezzo


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Health Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (WHO, 1948)

Dutch Translation What it contains (in Dutch)

Gezondheid Health Absence of disease or infirmity

Welvaart Welfare Prosperity and the extent to which needs can be satisfied with the available resources

Welzijn Wellbeing Happiness, quality of life, satisfaction with life, participation, social interaction, conducting a household, mobility etc.

Welvaart staat

Welfare state Protection of collective interests and protection and promotion of prosperity

Verzorging staat

Welfare state Protection of well-being, social security, providing rights to (health)care

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3. Pressure on the welfare state Development of costs and use of healthcare


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Good health Bad health

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In the welfare state: National government

€

Local government

Qu

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of life

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National government Local government

Shift from healthcare to promotion of participation

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4. From welfare state to participatory society Social support act • Introduced in 2007 replacing the

‘Welzijnswet’ and the ‘Wet voorzieningen gehandicapten’

• The Social Support Act aims to promote participation and well-being of citizens:

• As a goal in itself

• As a mean to directly prevent people from getting ill and use of healthcare

• As a mean to strengthen social infrastructures and informal (community) care and by doing so preventing use of healthcare


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4. From welfare state to participatory society Basic principles of the Social support act

Municipalities are to work together with other (professional) organizations

Transfer of participation and well-being and tasks to local parties under supervision of municipalities.

1

Services are to be tailored to individual needs and circumstances

Shift from ‘right to care’ to freedom of policy for municipalities.

2

People are responsible for solving their own problems and arranging support

Making society itself responsible for its own wellbeing and welfare

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People are to look after one another and support each other

A larger appeal on ‘the civil society’

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Principle Implication

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4. From welfare state to participatory society Assumptions and ambitions in the social support act

Social cohesion

Social and societal

participation


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Informal and ‘Community

care’

(Local) Government

• Reinforcement hypothesis

• Crowding-out hypothesis

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4. From welfare state to participatory society Ambitions and assumptions in the social support act

? Need for support in

• Conducting a household

• Moving in and outside the house

• Meeting other people and forming social relationships

From 2015

• Day care and guidance

• Transportation

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individual family friends,

neighbours

? ! ?

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neighbours

‘civil society’

! ?

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neighbours

‘civil society’

prof. organ.

govern-ment

!

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5. Lessons from the daily practice Combination of changes

A new balance between individuals, ‘social environment’

and government

A new balance between government

and its partners


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From governmental responsibility to

individual and societal responsibility

From diagnosis-treatment to tailoring

support to needs

From government to ‘professional

organizations’ under direction of local

government

Inter face

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What do we expect from each other? Be honest and transparent in communications towards people

1

What’s in it for them? Or is it just a cost cutback?

Focus on advantages for target groups 2

What do we expect from the ones that need to provide that support? Are they involved?

Don’t just focus on those who need support, but also on ‘the young’

3 Guide the transition from ‘right to care’ to ‘compensation when in need of support’

Consider it to be a cultural change

4 How to assess one’s needs and possibilities (alone and with social environment)

Know the people 5 23


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If there are financial relations, make sure they are based on value addition

Don’t consider it to be a ‘procurement’ issue 1

Accept differences in organizational goals. Societal effects bind organizations

Focus on ‘goals at the societal level’ 2

Make sure roles, responsibilities and tasks are clear and accepted

Strive for ideological and domain consensus in roles, responsibilities and tasks

3 Choose a role that fits the situation and context and make sure it is politically covered

Local governments have a crucial role and have to fill that carefully

4

Find other ways of governing a network, for example via trust

Formal vertical hierarchy is often absent 5

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Identify needs and possibilities of the person standing at the desk

Start with the person in front of you in mind 1

Bundle and coordinate service delivery around patients

Organize around the demand for support 2

Proactive service delivery is aimed at prevention and improvement of one’s social infrastructure

Combine reactive and proactive service delivery 3

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From welfare state to participatory society

Lessons from The Netherlands 7th Nordic Research Conference in Health Promotion June 2013

www.pwc.nl

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Rene van Kujik NHPRC 2013

Education

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