In the Netherlands long term care for elderly people, whether received at home or in nursing or residential care homes, is paid largely out of a compulsory insurance premium levied on the whole population, thus embodying the principle of social solidarity.
The 1967 Exceptional Medical Expenses Act (AWBZ), covers the medical costs for all chronic care that individual patients cannot meet through their normal health insurance. Everyone pays income related premiums fixed each year; these currently stand at about 10% of taxable income, up to a maximum of £1900.
In addition, elderly people must also make some personal contributions and payments to the cost of their care. Personal contributions are also income related and reflect savings made as a result of admission to a care institution. They are therefore lower for people who have dependants remaining at home.
There is also a range of voluntary payments for extras that older people may choose to buy in to their basic package of care. In 2000 these personal contributions made up 6.5% of the budget of home care for elderly people and a quarter of the budget for care homes.
The health ministry recently attempted to make the compulsory insurance package more adaptable to individual wishes, especially to remain independent. Pilot schemes offering older people personal budgets, which they can use to determine what sort of care to buy (in negotiation with their health insurers), have grown to cover 23 000 patients.
