Reforming Dutch long-term care: pushing back responsibilities to citizens and municipalities

The Dutch health system has been undergoing transformational reform since the mid-2000s. The 2006 reform introduced managed competition as a driving mechanism in health care. Ten years of gradual implementation have changed and continue to change the health care system and the role of stakeholders. A second major reform in long term care (2015) aimed to move citizens away from publicly provided care, urging citizens to be more self-reliant, while also placing broader responsibilities on municipalities. The new Dutch HiT provides an up-to-date assessment on both reforms, and the Dutch health system in general, and discusses important challenges for the future.