9.5.2 Connections to current sector developments
Bringing about demand-based care provision by means of modularity fits the spirit of
the times and current developments in the sector for long-term care for the elderly.
The political and financial systems are developing continuously to further stimulate
the efficient provision of demand-based care. In this respect, the Dutch government
will introduce a new financing system, known as care level financing (Dutch: ZZP
financiering) in the sector that provides care to elderly people living independently.
Care level financing has already been introduced in the sector for residential care for the
elderly. In the past, institutions received money for the number of beds they operated,
whereas the system is now working towards funding based on the number and type
of clients receiving care from an institution. The funding for care in kind is therefore
increasingly taking on the form of an individual-trailing budget (Ministerie van VWS,
2009a). On the level of the individual elderly client a care level package describes
what kind of care parts a particular type of client needs, as well as the intensity and
amount of care (i.e. number of hours) to which a client is entitled (Ministerie van VWS,
2009b). The results presented in this research may aid providers of care and related
services (both to elderly people living independently and to elderly people living in a
care residence) to restructure their care supply and delivery processes in line with the
care level packages. Modularity might provide a useful way to divide the total range
of supply into smaller components but at the same time organize these components
in such a way that coherent packages can be configured. Moreover, the findings of
this research point out the importance of other organizational aspects that need to
be well thought-out to provide coherent packages, such as interfaces and appropriate
processes for specification and reconfiguration.
Another development in the Dutch health care sector that can be seen in the light of
this research concerns the position of the bodies involved in carrying out the health
care financing sources (i.e. health care insurers, care offices and municipalities). In
the Netherlands, these parties act increasingly as representatives of health care clients
in their relations with care providers. This also concerns elderly clients of long-term
care and related services. In this role, the bodies involved in the effectuation of care
financing aim to purchase care services at the best possible price that also gives
high standards in regard to quality, accessibility and client-centeredness (Raad voor
de Volksgezondheid en Zorg, 2008). This research gives clues on how providers of
long-term care can improve the quality, transparency, and client-centeredness of care
provided. We provided insight into the organization of care components as well as the
mixing and matching of these components on the basis of individual client demands.
As such, our research may aid health care financing bodies to set standards on the
operational organization of long-term care providers to work towards their goals in
care purchasing.
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Modular
Care Provision
Along the same line of reasoning, the results of this project might aid client councils
and client interest groups in long-term care provision to elderly. These institutes very
much support the trend towards demand-based provision of care and services. Our
insights might help them to formulate advice to care providers on how to deal with
client involvement and demand-based care supply in day-to-day care practices.
9.6 Research limitations
The insights we have developed in this study, based on a review of the literature, a pilot
study, and four main case studies, fill some of the voids we identified in the current
body of knowledge on care and service modularity and demand-based care provision.
Yet, each study has its limitations and leaves room for additional research or leads
to new research questions. In this section, we address some of the limitations of this
study and the difficulties we encountered in the research process. In the next section,
we provide suggestions for future research.
9.6.1 Research perspective
One limitation of this study concerns the operations management perspective chosen.
In particular, we have concentrated on the concept of modularity. Even though we have
tried to bear in mind other perspectives that stem from either OM (such as process
(re)design) or other research fields (such as social and behavioral studies), modularity
was our main research lens. This has colored our assumptions, propositions, findings,
and results.
Our research perspective fed another limitation of this study. Since OM is concerned
with the design and management of operations within an organization, we focused
mainly on the supply side of long-term care provision. Since client involvement comes
naturally with the specification and delivery of care, needs and demands of long-term
care clients were taken into account, but only indirectly. Even though we assume that
modularity will enable providers to put their clients at the center of care provision, we
do not know whether modularity does indeed address those aspects of care provision
that are considered important by long-term care clients since we did not research the
demand side directly.
9.6.2 Research field
This study is based on empirical evidence from the long-term care sector and we
therefore have tailored our insights on modularity and demand-based care to the
situation and practices found in this setting. We tried to avoid this study being of interest
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Discussion and c
onclusions
Chapt
er 9