The Dutch youth care system used to face many problems. The system was fragmented; many different organizations that were funded by different authorities were involved in the care and support of children with physical, mental and behavioral problems. There was insufficient coordination between the organizations and the municipalities, a lack of integrality in the problem approach and an inadequate response to signals of unsafety. The Dutch youth care system was inefficient as well as ineffective, sometimes with dire consequences for the children involved.
Since January 2015, the Dutch youth care system is under construction. By adopting and implementing the Youth Act, the Dutch parliament decentralized all administrative and financial responsibilities related to youth care from the national and regional government to the 393 municipalities. The new youth care system should be more efficient, coherent and cost-effective by focusing on prevention, youth’s and parents’ own capacities, customized care and better cooperation between professionals.
With the transition of the Dutch youth care system, municipalities have become administratively as well as financially responsible for all youth care services. They have to contract youth care providers and give shape and substance to the relationship with these (often private) organizations. In order to do so, they need insight into the interventions, quality, results and effectiveness of support and care offered by youth care providers. At this moment, most Dutch municipalities are, separately or jointly in regional youth care alliances, struggling with the development and implementation of some form of result-based financing.
This paper explores the conditions and challenges of result-based financing from the perspective of municipalities as well as youth care providers and sketches the outlines of a system of result-based financing in youth care based on the results of two empirical studies that were recently conducted by the Research Institute Youth, which is part of the Research Centre Health Care and Social Work of Windesheim, University of Applied Sciences in Zwolle, the Netherlands. In the course of these studies, representatives of various youth care regions and municipalities as well as directors and professionals of youth care organizations were interviewed on the opportunities and constraints of result-based financing in youth care.
E3 - Health Care Management Reforms – Public Policy, Management and Accountability
