Workshop 1.6 - Deutscher Verein für öffentliche und private Fürsorge

• Definition of the directional role at a local level. Local authorities often play a key role, but that does not mean that they automatically
assume the directional role as well.
• The improvement of the cooperation. In many areas, cooperation between social services, employment services, and welfare and care
institutions can be improved, with the aim of creating an appropriate range of services and reaching the whole target group.
• The structural incorporation of social activation activities. Social activation is often organised on a project basis. Transforming it into
a structural component is the next step and in many cases this step has not yet been taken.
• Expanding the consultants’ and supervisors’ knowledge and skills. Consultants (with employment services, social services, welfare
organisations etc.) do not always have sufficient knowledge or expertise to implement social activation activities. This includes the
skills relevant to dealing with the target group and knowledge of the range of social activation services.
• The development of demand-driven services. Delivery of social activation activities is still too often driven by the supply side,
whereas social activation is only really effective when it satisfies genuine ‘customer’ demand.
• Increasing target group reach. The social activation target group consists, almost by definition, of people who are difficult to reach.
The normal channels are often not adequate for recruitment and selection.
• Finding a balance between the voluntary nature of the programme and the need for commitment. Although there are many situations
in which social activation cannot be made compulsory, various research studies have shown that a lack of formal commitment to a
social activation programme does not help to increase its effectiveness.
• Tapping and redeploying available resources. There is often no comprehensive overview of the funds that can potentially be used for
social activation purposes.
3. Patient and consumer influence on health care
The Dutch government has been working for some time to strengthen the position of the patient/consumer. The last government
memorandum on patient policy had two basic themes: strengthening the individual legal position of patients and clients, and increasing
the influence of the organised patient/client by funding the patient and client movement and other initiatives. This led to the necessary
legal measures. Shortly after the memorandum was issued, three important Acts were passed and came into effect: the Client’s Right of
Complaint Act in the Care sector (WKCZ), the Medical Treatment Contracts Act (WGBO) and the Participation Act for Clients in Care
Institutions (WMCZ).
In addition, regulation of the funding of patient and client organisations was improved, which made patient organisations a good deal
stronger. The Patients’ Fund Foundation, for example, was set up in 1996. Every year this foundation disburses money to the various
national patient and client organisations. The annual amount distributed is currently more than 18 million in Euros. The foundation’s
responsibilities and activities were taken over on 1 January 2003 by the PGO Fund, whose aim is to help strengthen the position not
only of patients, but also of the handicapped and the elderly. The foundation provides subsidies for this purpose to national patient
organisations, organisations for the handicapped and senior citizens’ associations.
Strengthening the legal position of the individual and increasing the influence of the organised care user were important, indispensable
steps. The Acts referred to have now been evaluated and we can conclude that a solid legal foundation has been laid for reinforcing the
legal status of care users. The involvement of the patient and client organisations has been quite marked in many areas – for example
in the role they have played in the development of long-term agreements. At the same time, the question remains whether we can do
enough to perfect these instruments.
Health care should offer people a range of effective, good quality services for which they can insure themselves for an acceptable
premium and which are set out in clear agreements. The developments I have outlined will make care users want more freedom of choice
and a range of services with more variety. This will put the care user in a stronger position vis-à-vis the traditionally more dominant
care provider. We foresee a future in which the care provider’s ‘market’is not automatically guaranteed, but depends partly on the pattern
of choices made by the care user or the insurer who acts on behalf of the insured and purchases or finances health care.
We wish to continue encouraging this development by further empowering and supporting care users when it comes to deciding on
health care and insurance. Our policy aim is therefore to empower and/or support care users so that they are able to formulate their
wishes and needs in such a way that health care providers and insurers take those wishes and needs even more into account.
Care users can be empowered in various ways. We distinguish five levels of empowerment:
1. proper legal status for care users;
2. current, accessible and reliable information that enables care users to understand the level of quality of the services offered by health
care providers and health insurers;
3. independent, reliable and easily accessible sources of advice and support. Care users must, where necessary, be able to seek advice
and support when deciding on their requirements and their choice of health insurance or a particular care product;
4. individual and collective purchasing power. Care users must have the opportunity to purchase health care products themselves or put
together health care packages based on a previously determined budget, whether this is done through the direct intervention of an
insurer or not;
5. Collective negotiating power that is representative of care users and is transparent in its dealings. If health care providers and insurers
do not take the wishes and needs of care users sufficiently into account, there is then the opportunity to make customer dissatisfaction
known or to make it a subject for negotiation. People can also delegate this power to organisations that represent their collective
interests.
There are good developments on all these five levels. But since I did consume the time that is given to me I will leave it to this. I thank
you for your kind attention.
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