[Possible substitution between intramural and extramural care. An exploration from a needs approach]. / Mogelijke substitutie tussen intramurale en extramurale zorg. Een verkenning vanuit een behoeftenbenadering.

This article concerns the possibility of substitution within the health and welfare system for the aged, in particular the possibility of shifting from institutional care (homes for the aged) towards community care (home care programmes). Based on an analysis of the need for support among elderly persons requesting admission into residential homes, it was concluded that such a shift will be possible. Attention was then paid to the planned introduction of more restricted admission-norms as part of old-age-policy in the Netherlands. Of some importance is whether this more strict admission-policy will lead to a decline in the percentage of elderly in residential homes below the existing norm of 7%. This seems unlikely, mainly because most of the aged requesting admission into residential homes already have such a need for support that they will meet the requirements of a more restricted admission policy.

[Control of allocation through decision making on requests for care. Study of indications for nursing homes]. / Beheersing van een voorziening via het beslissen over hulpvragen. Onderzoek naar de indicatiestelling voor het verzorgingstehuis.

The allocation of social services is the central theme in this article. More in particular attention is drawn to the admission-decisions for residential homes. The Dutch government has created specific regulatory forms to control the admission policy of private institutions in this field. Two interrelated goals are associated with this regulation: first that of selectivity (admission restricted to those 'in need'), and second that of objectivity (equal treatment and equal opportunities with regard to admission). This article gives the results of an empirical investigation into the problem of goal-attainment. It is concluded, that both selectivity and objectivity are only partially achieved. These findings will be relevant for intended changes in admission-policy. Current proposals present the choice between more or less centrally guided admission norms, favoring the latter. However, from the theory of rationing this can be seen as a shift towards a more hidden system of rationing, which is less predictable in outcome contrary to the aforementioned goals of selectivity and objectivity.