Reforming the Long-Term Care System: The Cases of England and the Netherlands

Long-term care (LTC) reform is happening around the world, especially in developed countries. Reform initiatives are being driven by several factors: lack of coordination, inefficient service arrangements, less than optimum quality, poor outcomes, and/or difficult-to-control costs. England and the Netherlands not only represent two different LTC models, but also differing approaches to LTC reform. In addition to examining the respective policy frameworks and financing/service delivery infrastructures that have traditionally defined the LTC systems of England and the Netherlands, the paper describes the drivers of LTC change that have emerged in each country. Next, it summarizes the reforms that have been proposed or implemented to re-finance, re-balance, and/or re-organize LTC in each of the countries and the outcomes found to date, if any. Finally, this review concludes with a discussion of the implications and lessons of these international LTC reform efforts for the U.S.