The Netherlands: institutional fragmentation in a patient-centered system

The chapter analyses the challenges, obstacles and solutions for better coordination of healthcare and long-term care in the Netherlands, based on interviews with major stakeholder organizations. In the Netherlands, both healthcare and long-term care are organized as universal social insurance systems. However, long-term care is divided between homecare and care in nursing homes. This institutional split within the long-term care system further complicates effective coordination between healthcare and long-term care. However, at the staff level, both systems are highly professionalized, which is particularly true for long-term care by international standards. These professional structures are organized around the individual client and partly compensate for institutional shortcomings. Nonetheless, most Dutch organizations criticize the complexity of the overall system, which often impedes effective coordination. Another major problem is shortage of staff, which limits available resources for client-centered coordination.