In 2022: revolutionising home care in the Netherlands

 The Netherland home healthcare market size stood at USD 570.0 Million in 2018 and is projected to reach USD 1,013.1 Million by 2026, exhibiting a CAGR of 7.6% in the forecast period (2022-2026)

Supportive Government Acts & Policies Along with Increasing Healthcare Expenditure on Elderly Population Likely to Drive the Netherland Home Healthcare Market During the Forecast Period

The Health Insurance Act and the Long- Term Care Act amongst others are the basic foundation of the Netherlands overall healthcare system. The Netherlands government allocates heavy budgets for the implementation of these two important acts each year. The Health Insurance Act deals with hospital care while that of Long-Term Care Act deals with the other types of care, which includes, elderly care, home healthcare and others. Increasing prevalence of chronic conditions and supported by favourable government policies are expected to boost the adoption of home healthcare products in the Netherlands during the forecast period.

Long-Term Care Act, enforced in 2015 deals with the group of elderly patients who are suffering from dementia, physical disability, and long term psychiatric disorders. Moreover, by enforcement of this law, the government has given more priority to home healthcare as compared to institutional care, which is expected to drive the growth of the Netherland home healthcare market during the forecast period.

If you are in need of medical care but don’t have to stay in a hospital, you can apply for a wide range of home care services. More than half a million people in the Netherlands live in nursing homes, or use home care (thuiszorg) or maternity care (kraamzorg).

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Home care for the elderly and disabled
The government’s policy in recent years has been to help as many elderly people as possible to live in their own homes, as this is cheaper than placing them in nursing or care homes. If you live at home and are elderly or disabled, you get assistance from home care organisations. In order to arrange this, the first step is to visit your GP (huisarts) to discuss your needs. To apply, you can ask your doctor or have a look at zorgkaartnederland.nl/thuiszorg (in Dutch).

Next, an assessment is made of the needs you may have, as well as how family, friends and neighbours can assist. As a result, most home care consists of a mixed program of nursing from professional care providers and help around the house from informal carers. Professional carers will be able to help with simple medical tasks, such as changing wound dressings, handing out medication or taking blood pressure readings. They can also provide assistance with a wide variety of day-to-day activities, such as getting in and out of bed, dressing and undressing, going outside, eating and drinking, using the toilet and personal hygiene. Those depending on home care can also receive shopping assistance and dietary advice. If necessary, other care providers will visit you at home, such as physiotherapists, mental health professionals et cetera. As the main providers of care, district nurses (wijkzuster) are the first point of contact and liaison with the municipality to coordinate a client’s needs. They also stay in touch with family and friends and other informal caregivers.

Key players covered in the global Netherlands Home Healthcare Market research report:

• Molnlycke Health Care
• Smith & Nephew Plc
• ConvaTec Group plc
• Coloplast
• Braun
• Melsungen AG
• Hollister Inc.
• Fresenius Medical Care
• Acelity L.P.
• Medline Industries Inc.

The challenge

In the 1990s, the Dutch government was concerned about the increasing levels of spending and inefficiency in the health system.[1] Dutch leaders therefore wanted home care organisations to account for their business performance to insurers.[2] In 1987, The Dekker Report Willingness to Change also made recommendations for a more prominent role for the family in the care of their older relatives in their own homes.[3] This inspired a change from a publicly-subsidised institutional care system to a more privatised home-based care regime, introducing private sector management tools in the Dutch long-term care sector. These reforms followed the trend of so-called New Public Management in the public sector, which was spreading across the world in the 1990s.

These reforms were intended to increase both standardisation and specialisation, with different tasks being delivered by different types of care professionals. This was because home care companies were reimbursed at different rates according to the complexity of the care “product” delivered, introducing opportunities to boost margins. As a consequence, most home nursing organisations merged into large, regional home care organisations, where nurses had lower levels of autonomy: “nurses were, for example, provided with even more specific plans that had to be adhered to, and deviations had to be explained to managers”.[4]

Decision powers on what care needed to be provided were handed from frontline staff to an external regional assessment organisation [Regionaal Indicatie Orgaan] (RIO).[5] To contain costs, RIO needs assessments specified in great detail which tasks were to be provided by helpers, nursing aides, or level 4 and 5 nurses. In this way, basic domestic services such as assistance in getting dressed could be performed by cheaper resources, while medically trained personnel were freed up to administer more complex interventions. Finally, staff had to report outcomes according to set performances indicators, ensuring consistency and evidence-based healthcare.[2]

By the mid-2000s, however, home care had become fragmented, of lower quality, and surprisingly inefficient. Despite reforms being targeted at cost containment, the sector was faced with the persistent problem of uncontrollably rising costs. The percentage of GDP spent on long-term care increased from 2.8 percent in 1996 to 4 percent in 2005, growing by more than 10 percent in some years.[6] This resulted partly from profit incentives to deliver more care products with cheaper resources, which were pursued at the expense of preventive measures.

These reforms meant that the patient experience was also jeopardised. Some patients were seen by more than 30 different healthcare professionals, each administering a different task such as helping with bathing, giving an injection, or caring for a wound. Sometimes, patients were visited several times by different care personnel on the same day. The personal bond between nurses and patients was lost, and no one took ownership for an individual patient's overall health and wellbeing - they lacked the incentives and autonomy to do so.[7]

The quality of care delivered to patients was also negatively affected. Nurses regularly found patients in a condition they were unprepared for, as a significant amount of time had lapsed between the RIO assessment and their first visit. Yet because frontline care staff were only authorised to provide certain care products in an agreed timeframe, specified to the minute, the care actually needed could not be provided. Overall, the extensive need for timekeeping meant less time could be spent on actual care.[2]

Needless to say, this left nurses disheartened and feeling that their increased responsibilities for timekeeping and documenting their tasks adversely affected personal care.[8] A 1999 focus group of home care professionals revealed major frustrations over the paradigm shift which had stripped nurses of their professional independence in diagnosing and assessing client needs. “In the past, I could agree on things with people myself… Now I come to these people and just have to execute [on the indication that's been given to me.] Our profession has just been eroded,” said one participant. As a consequence, many nurses experienced “burnout feelings and discouragement to remain working in the profession” with sickness absence rates as high as 10.4 percent.[2]

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