In several regions, families caring at home for a severely disabled child or relative are suddenly losing their additional financial support. New applications for so-called meerzorg, an allowance on top of the personal care budget (persoonsgebonden budget, or pgb) under the Long-Term Care Act (Wet langdurige zorg, Wlz), have been assessed far more strictly since last year. This has led to major regional disparities and deep uncertainty among families who often provide round-the-clock care for their loved ones. According to Martin Buijsen, Professor of Health Law at Erasmus School of Law, the issue concerns not only implementation and policy but also fundamental rights. “If someone’s situation has not changed, a care office must have a valid reason to refuse a new application. People have a right to care, and that means you cannot simply stop providing it.” Buijsen was interviewed on RTL Nieuws about the issue.
What is meerzorg?
People with a Wlz indication receive a fixed budget to cover long-term care. When that budget is insufficient to provide the necessary care, they can apply for meerzorg through their regional care office. This additional funding makes it possible, for instance, to arrange specialised support or 24-hour care at home.
The allocation of meerzorg is intended to be tailored to individual needs, based on guidelines from the Dutch National Health Care Institute (Zorginstituut Nederland). However, recent differences between care offices show that these guidelines leave room for divergent interpretations. Buijsen explains: “The current advice is unfortunately not sufficiently clear and allows for multiple interpretations. What we now see is that care offices belonging to certain insurance groups interpret the guidance more strictly than others, resulting in regional differences for patients with the same need for long-term care.” As a result, families in one region may still qualify for meerzorg, while similar applications are rejected elsewhere.
Regional disparities and fundamental rights
The Wlz is a national law. Nevertheless, its implementation by the 31 regional care offices, each overseen by a single health insurer, is far from uniform. These regional discrepancies raise questions about equality before the law. Buijsen sees a risk here: “The right to equal treatment is at stake, although proving discrimination will be extremely difficult, since meerzorg is always a matter of individual assessment.”
In his view, the issue concerns not only equal treatment but also the fulfilment of international obligations. “Access to long-term care is part of the fundamental right to health care. This is a social right, and social rights are subject to the principle of progressive realisation. That principle is undermined when meerzorg that was previously granted is later withdrawn even though the care needs have not diminished.”
Buijsen’s approach of viewing long-term care as a fundamental social right that cannot be scaled back aligns with international treaties such as the International Covenant on Economic, Social and Cultural Rights (ICESCR) and the UN Convention on the Rights of Persons with Disabilities (CRPD).
Home care or institutionalisation
For many families, the loss of meerzorg means they can no longer care for their child or partner at home. It is sometimes suggested that institutionalisation is the only option. However, according to Buijsen, this runs counter to international obligations: “The Convention on the Rights of Persons with Disabilities, to which the Netherlands is a party, requires that clients be cared for and supported in their home environment as far as possible.”
Families who lose their meerzorg have little recourse other than to file an objection and, if necessary, take their case to court and then to the Central Appeals Tribunal. This, however, is a lengthy and burdensome process, especially for families already carrying heavy care responsibilities.
A broader social responsibility
Ultimately, the meerzorg issue raises a fundamental question: How does the Netherlands safeguard the right to long-term care? The current situation highlights the vulnerability of families when legal norms are applied inconsistently. Buijsen, therefore, calls for structural solutions: “First, clearer guidance from the National Health Care Institute. Second, greater awareness among care offices that fundamental rights are at stake here.”
Clear regulation and consistent implementation, he argues, are crucial, not only to ensure equality before the law, but also to uphold the human dignity on which the entire care system is founded.
- Professor
- More information
Read the RTL article here (in Dutch).
- Related content
