A new social support model – performance-based funding under the Social Support Act

Since 1 January 2013, the regional social services unit for the Drechtsteden area in the Netherlands’ South Holland province has been procuring domestic support based on performance agreements with care providers. By putting performance first, instead of the number of hours of support provided, care providers are incentivized to work more efficiently. The new method comes with benefits for users, for the Drechtsteden region, and for care providers.

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The regional social services unit, Sociale Dienst Drechtsteden (SDD), works for a total of seven local authorities in the Drechtsteden area, paying benefits and arranging support for residents. In the Netherlands, responsibility for benefits and social support has been devolved to local authorities, who receive funds from national taxes to perform these tasks as part of the implementation of the Social Support Act (Wet Maatschappelijke Ondersteuning). Residents receive practical support whenever they are insufficiently self-reliant and do not have a personal network to fall back on. The idea behind this kind of support is to ensure that residents can continue to live independently and be active members of society for as long as possible. Residents can, for example, turn to their local council for domestic support. In the Netherlands, such support is not only offered when someone has a long-term care need, but also in other cases. In countries such as Denmark, Germany, and Austria, domestic support is provided only to people with long-term care needs.

Since 2007, local authorities have been responsible for providing domestic support to their residents under the national Social Support Act. Nearly all local authorities have opted to basically continue existing services as provided under the Exceptional Medical Expenses Act. This means that the local authority looks at how much support a user needs and captures that need in a number of hours of support per week. The local authority subsequently enters into a contract with a care provider, under which the care provider provides the agreed number of hours of support and bills the local authority based on the hourly rate specified in the contract. In practice, care providers almost always bill local authorities for the agreed number of hours. After all, if they manage to clean someone’s home in fewer hours, they will earn less money. And so, it is all about the number of hours, and not about the end result. There is no incentive for the provider to work as efficiently as possible.

In late 2011, one care provider initiated a rethink of the procurement model for domestic support in the Drechtsteden region (260,000 inhabitants). ‘Why are you still so keen on estimating costs based only on hours of care provided?’ was the question this care provider asked. This question marked the start of an innovative procurement process that has culminated in an entirely new procurement model. The new model no longer revolves around the number of hours of care provided but instead consists of the care provider and the user agreeing on a certain end result. This also factors in what the user can still do himself or herself or what informal carers from his or her environment can do. The agreement on the end result is recorded in great detail in a support plan that both parties sign and is subsequently submitted to social services.

The twenty care providers contracted to SDD have agreed on a fixed price for domestic support per four-week period with SDD. For some users, the care provider can achieve the agreed end result in fewer hours than before, while they may need more time for others. The newly agreed fixed price is lower than the average costs that social services used to cover per user.

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Year: 2013
Level of government: Regional/State government


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