From welfare state to participatory society

1. From welfare state to
participatory society
Lessons from The Netherlands
7th Nordic Research Conference in Health Promotion
June 2013
www.pwc.nl

2. PwC
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
2
June 2013From welfare state to participatory society

3. PwC
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
• …
June 2013From welfare state to participatory society
3

4. PwC
1. Population ageing
Old age dependency ratio in Europe in 2010
June 2013From welfare state to participatory society
4
10-20%
20-30%
30-40%
40-50%
50-60%
60-70%

5. PwC
1. Population ageing
Old age dependency ratio in Europe in 2060
June 2013From welfare state to participatory society
5
10-20%
20-30%
30-40%
40-50%
50-60%
60-70%

6. PwC
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?
June 2013From welfare state to participatory society
6
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
0
2
4
6
8
10
12
14
16
18
Xmln
0-20 20-64 65+
Old age Young age

7. PwC
2. Population ageing in The Netherlands
Characteristics of ‘the group’ elderly
• ‘The elderly’ are a fast growing
group, but also a extremely
heterogeneous group
June 2013From welfare state to participatory society
7

8. PwC
2. Population ageing in The Netherlands
Characteristics of ‘the group’ elderly
In The Netherlands there are currently about 2,6 million people over 65:
June 2013From welfare state to participatory society
8
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%

9. PwC
2. Population ageing in The Netherlands
Semantic intermezzo
June 2013From welfare state to participatory society
9
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

10. PwC
3. Pressure on the welfare state
Development of costs and use of healthcare
June 2013From welfare state to participatory society
10
Good health Bad health
Lowuseof
healthcare/
lowcosts
Highuseof
healthcare/
highcosts

11. PwC
3. Pressure on the welfare state
Development of costs and use of healthcare
June 2013From welfare state to participatory society
11
Good health Bad health
Lowuseof
healthcare/
lowcosts
Highuseof
healthcare/
highcosts

12. PwC
3. Pressure on the welfare state
Development of costs and use of healthcare
June 2013From welfare state to participatory society
12
Good health Bad health
Lowuseof
healthcare/
lowcosts
Highuseof
healthcare/
highcosts

13. PwC
3. Pressure on the welfare state
Development of costs and use of healthcare
June 2013From welfare state to participatory society
13
Good health Bad health
Lowuseof
healthcare/
lowcosts
Highuseof
healthcare/
highcosts
In the welfare state: National government
€
Local
government
Qualityoflife

14. PwC
3. Pressure on the welfare state
Development of costs and use of healthcare
June 2013From welfare state to participatory society
14
Good health Bad health
Lowuseof
healthcare/
lowcosts
Highuseof
healthcare/
highcosts
National governmentLocal government
Shift from healthcare to
promotion of participation

15. PwC
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
June 2013From welfare state to participatory society
15

16. PwC
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
3
People are to look after one
another and support each other
A larger appeal on ‘the civil
society’
4
16
June 2013From welfare state to participatory society
Principle Implication

17. PwC
4. From welfare state to participatory society
Assumptions and ambitions in the social support act
Social
cohesion
Social and
societal
participation
June 2013From welfare state to participatory society
17
Informal and
‘Community
care’
(Local)
Government
• Reinforcement hypothesis
• Crowding-out hypothesis

18. PwC
June 2013From welfare state to participatory society
18
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

19. PwC
June 2013From welfare state to participatory society
19
4. From welfare state to participatory society
Ambitions and assumptions in the social support act
individual
familyfriends,
neighbours
?!?

20. PwC
June 2013From welfare state to participatory society
20
4. From welfare state to participatory society
Ambitions and assumptions in the social support act
individual
familyfriends,
neighbours
‘civil
society’
!?

21. PwC
June 2013From welfare state to participatory society
21
4. From welfare state to participatory society
Ambitions and assumptions in the social support act
individual
familyfriends,
neighbours
‘civil
society’
prof.
organ.
govern-
ment
!

22. PwC
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
June 2013From welfare state to participatory society
22
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

23. PwC
5. Lessons from the daily practice
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
June 2013From welfare state to participatory society

24. PwC
5. Lessons from the daily practice
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
24
June 2013From welfare state to participatory society

25. PwC
5. Lessons from the daily practice
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
25
June 2013From welfare state to participatory society

26. From welfare state to
participatory society
Lessons from The Netherlands
7th Nordic Research Conference in Health Promotion
June 2013
www.pwc.nl
© 2013 PwC. All rights reserved. Not for further distribution without the permission of PwC.
"PwC" refers to the network of member firms of PricewaterhouseCoopers International
Limited (PwCIL), or, as the context requires, individual member firms of the PwC network.
Please see www.pwc.com/structure for further details.