JILPT Research Report No.167
Comprehensive Community Care in the Netherlands:
Enhancing care provision system and securing care workers

May 30, 2014


Research Objective

As population aging advances, there is a growing debate on reorganizing the system of a sustainable healthcare and nursing provision service that can cope with the ever-rising number of the elderly suffering chronic disease. Building a system of comprehensive community care that can help them to continue living with dignity in their own familiar communities is now a matter of urgency.

Based on problem awareness of how to secure care providers in the system of comprehensive community care in Japan, this report focus on the Netherlands, where pioneering efforts to integrate community-based care have long been made and the healthcare system has been highly praised internationally, and examines the debate on the system of care service provision and care providers in the Netherlands within a historical context.  The purpose in doing so is to obtain suggestions aimed at developing system of care service provision and broadly securing care providers in Japan.

Research Method

The Research is conducted through literature survey and interview survey (including overseas survey).

Major Findings

Systems of comprehensive community care in Japan are understood to be those in which the focus is on reforming service provision systems as "integrated care" including a community-based element, in line with global trends.

This report first gives an overview of the debate on constructing a system of comprehensive community care in Japan and its providers, as well as policy and Research trends related to care workers and integrated care in other countries. On this basis, the report examines changes in care provision services and related policies in the Netherlands equivalent to components of Japan's comprehensive community care system, as well as the current status of care provision services using internationally comparable categories from the viewpoint of integrated care. Besides this, focusing on nursing and care professionals among care workers in general, we look at the structure of qualifications and quality management, as well as the nature of development and growth of qualification systems, and then summarize policies aimed at broadly securing and activating care providers.

Along with the trend towards dehospitalization in the 1960s and deinstitutionalization in the 1970s, the policy was going in the direction of functional separation of secondary care and primary care, consistently strengthening primary care and putting emphasis on community healthcare and preventive care. These conduced to the efforts to improve the integrity of primary care. Then, as the expansion of the welfare state reached its end, there came a series of reforms focused on "self-responsibility" and "participation", in which it is important, in long-term care, to pursue "individually tailored care" together with "substitution" of less expensive care for concentrated expensive care. In this way, horizontal and vertical integration inside and between the medical/social care sectors, and combinations of various forms of care at home progressed. Care provision systems, where implementation and operation had traditionally been entrusted to small-scale religious or sectarian non-profit organizations closely tied with the small community, underwent a major transformation amid secularization and market-oriented policies. In the 1990s, expanding waiting lists, non-professional care led by providers, and incomplete substitution became major issues. Throughout the 2000s, together with a conversion from a provider- or domain-specific approach to a functional approach, infrastructure development aimed at evaluation based on quality and results and reforms designed to expand the discretion of professionals and businesses, repeated efforts have been made to re-establish care rooted in the community, from the aspect of social participation and public health. And recently, while again emphasizing the enhancement of multi-professional primary care and the roles of welfare and public health at district level, the stress has been on health promotion, enhancement of self-management, attempting to solve problems amid familiar relationships.

Against the backdrop of an increasing need to review the professional training system, caused by the progressive integration in the care sector, a wave of vocational training reforms surged (across all industries) with the aim of strengthening links between labor market needs and vocational training and raising the employability and international competitiveness of workers. Steps were taken to develop national-level qualification frameworks and nationally standardized vocational qualifications and to reorganize vocational training institutions, with a view to combining secondary-level vocational education with adult education. In the care sector throughout the 1990s, various occupations were inventoried and analyzed through experimental projects based on collaboration between stakeholders at community level, and in 1997 a new qualification structure was applied. Knowledge Center for Vocational Education and Training and the Labor Market in each industry (for cross-sectoral care in health, welfare and sports) provides a platform for stakeholders in industry and education and are continuously reviewing job profiles and qualification profiles. Qualifications are certified in modules, and there are courses for trainees to learn while working, where on-the-job training accounts for more than 60%, also there is a system for certifying previously-acquired vocational experience and training, though a lot of home works are assigned. These encourage not a few people to get continuing education while working in the care sector.

On securing and activating care workers, not only are there ongoing efforts to secure and retain care workers from the viewpoints of innovation, the retention and demonstration of ability of incumbents, hiring and securing new human resources, and strengthening the local labor market, but also steps are being taken to promote the participation of various entities by diversifying care provision formats. Meanwhile, there are frameworks for promoting the independence and participation of various parties and demonstrations of their ability, while efforts aimed at supporting self-management and informal care providers have been growing in recent years against the background of the chronic disease care model. Given the adherence to a direction of lifelong participation and orientation to self-responsibility across social security policies in general, the importance of supporting informal care providers is further increasing.

Policy Implications

In order to construct a system of comprehensive community care in which residents (patients)-centered care is provided efficiently with quality, and to secure providers for such a system, the main suggestions and issues obtained from the experience of the Netherlands have been compiled from five viewpoints as follows: (1) “community-based” integration and community design, (2) strengthening the functions of multi-professional collaborative primary care, (3) qualification structure review and continuous development based on cross-sectoral dialog, (4) evolution of innovations to raise the care work capacity of society as a whole, and (5) linkage between care-related policies and labor policies.

Policy Contribution

This Research could provide basic material for study on systems of comprehensive community care, the appropriate formation and utilization of human resources, and the utilization of social capital, among other issues.

Moreover, the author puts the content of this Research to practical use in reports and statements as a member of the Working Group for Long Term Care Benefits of the Advisory Council on Social Security, the Comprehensive Community Care Research Group, the Survey Research Project on Promoting the Securing of Human Resources in Nursing Care, the International Comparative Research Project on International Trends in National Dementia Strategies and Service Models Based on these, the Study Group for Japan’s International Contribution to ‘Active Aging’, the Expert Council for Revitalizing Local Communities and the Study Group on the Organization and Operation of the Nursing Care Work Stability Center, among others.


  1. Cover – Preface Authors – Contents
  2. Part Ⅰ  General discuss–ion
  3. Part Ⅱ  Policies and measures on care provision system and care workers in the Netherlands

Research Categories

Project Research “Survey Research on vocational capability development systems in response to economic and social changes”

Subtheme “Survey Research on directions for capability development and career formation inside and outside company”

Research Period



Satoko HOTTA
Researcher, Japan Institute for Labour Policy and Training

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