Promoting aging in place through flexible care options: recent developments from the Netherlands[Encourager le maintien à domicile des personnes âgées dépendantes par des modalités alternatives de financement public ? L'expérience récente des Pays-Bas]

Free choice, ageing in place, financial accessibility and the containment of public spending are focal topics in the public debate about long-term care policies. In order to better balance these objectives, the Netherlands have developed new financing options, in-between between publicly subsidized home care and nursing home care for individuals with moderate to severe care needs. Those may choose to receive either vouchers (PGB), with which they can arrange care themselves, a Full Package at Home (VPT), or a Modular Package at Home (MPT). With VPT and MPT, a comprehensive package of care is provided in-kind, but in theory outside a regular nursing home. Little is known about the role played by these care options. This article describes the design of PGB, VPT and MPT, notably in terms of the cost-sharing between the recipient and the public long-term care insurance. In addition, it leverages aggregate statistics and individual-level administrative data to shed light on the use of these care options. Individuals with more limited care needs and higher-income individuals are more likely to take up these alternative care options, which are suggested to contribute to the development of non-contracted private nursing homes. By favoring the development of a two-tier system, these care options might undermine equity in long-term care receipt and in its financing, which underpins the Dutch social long-term care insurance. The Dutch case illustrates the trade-off between universal access and free choice in care.