Not only do organizations compete, they also work together. There is a tendency to cooperate with other forms of care, like nursing homes and residential homes. Between these fields transfers of clients take place. By enhancing cooperation between these institutions it will be easier to transfer a client from one form of care, for instance home care, to another form of care, for instance a residential home. Also, the cooperation between home care and hospital care has grown.
A last trend that is prominent in home care is the trend to a rise in productivity. Because of the lack of resources, organizations put a high pressure on their employees to raise productivity.
In order to get some insight in the ways the employees spend their time, they now have to register every client contact.
Home care in the Netherlands may be well organized, it is not without problems.
Home care, being a form of basic care considered as 'uninsurable risk', is financed through the Exceptional Medical Expenses Act. As a consequence the money that is available is always limited. In contrast to insurances, which are always in a certain way a matter of supply and demand, this basic care is a matter of scarcity.
A few years ago a 'personal budget' system was introduced: People who need home care can obtain a certain amount of money to purchase care from the provider of their choice (regular non-profit agencies, private bureaus, or informal carers). In many cases, clients decide to pay their informal carers, so that less money is available for the existing organizations.
Another way of spending the money for home care is by 'outputpricing': home care organizations have to make deals about their production for certain products. It is a way of budgeting the organizations by only making money available if the production is within
