Wachtlijstontwikkeling in de zorg voor verstandelijk gehandicapten

This report presents the results of a series of model simulations on the waiting list for residential care of the mentally disabled in the Netherlands. The model assesses the number of mentally disabled in the Netherlands, the institutional and semi-institutional residential care and the waiting lists for these types of care. Future developments in the waiting list are explored by means of studying scenarios showing the effects on the waiting list of alternative forms of ambulatory care, a lower level of outflow from the waiting list, an improved waiting-list registration and the increased survival of the mentally disabled population in residential care. The period 1996-2010 shows a growth in the number of mentally disabled in the Dutch population of 5.0% (from 104,400 to 109,700). In the subsequent years 2010-2020 the growth gradually decreases. There are increasing numbers of ageing mentally disabled persons: in the period 1996-2020, the number of mentally disabled over 65 years of age shows more than a doubling. In the reference scenario, based on developments in the 1996-1998 period, the waiting list for residential care of the mentally disabled increases from over 6,800 clients in 1996 to 8,200 in 2000. After this year the waiting list decreases due to an assumed decreasing inflow into and a larger outflow from the waiting list, partly because of a growing capacity of the institutions. The scenario home-care describes the situation in which after 2002 provision of suitable alternative ambulatory care reduces the inflow into the waiting list by 38%. As a result, the waiting list decreases rapidly to 3,000 in 2010 and less than 1,000 in 2020. The scenario less outflow takes a variant assumption on the unspecified fraction of the outflow data in the waiting list registration, resulting in a reduced outflow to other care than institutional and semi-institutional residential care. In this scenario, the waiting list increases to 10,900 in 2007, after which a decrease follows to 9,600 in 2020. The scenario clean waiting list assumes, based on actual data from a regional investigation, that the waiting list has a 20% over-registration. In this scenario the waiting list develops from 5,500 in 1996 to a maximum of 6,800 in 1999. After this year the waiting list decreases to 4,600 in 2010 and 3,500 in 2020. Finally, in the scenario improved survival the mortality rates of the mentally disabled in the institutions in the period 2000-2020 are assumed to be reduced by 10%. As a result, the waiting list increases to 8,200 clients in 2000. After this year the waiting list decreases to 4,900 clients in 2020. In order to make more accurate projections of possible bottlenecks in providing appropriate care for the mentally disabled, it is important to update the estimate of the number of mentally handicapped in the population and to improve the waiting-list registration and the quality of semi-institutional registration. The developed model can be expanded to study regional aspects of the waiting list problem, cost allocations, and the effects of changing incidences of mental handicap