Answers ASD to Nota Inkoopstrategie begeleiding Wmo from BOV, Dommelvallei+, Kempen
 

Questions to Advisory Councils:

1. The biggest change is that we are moving from outcome financing to a p x q system. The main argument for this change is that we want to have more insight into what the client actually receives in terms of counseling. This is also clearer for the client. This also allows us to steer better. What do you think of this adjustment?

The paper talks about objectives and outcomes. The two terms are not identical. The assumption in the paper is that if the objective is chosen, the result (automatically) follows. This seems too simple an assumption in the real world. Example: If the objective is "a sufficiently clean house to live in," then without further specifications that is a non-operational formulation. It will be easy for the client, the counselor and the provider to agree on the objective. But on the outcome, opinions will differ, and thus lead to conflict. And how can you determine who is right?

In a perfect world, outcome financing is best. You want to achieve something as a client and counselor (result) and agree between counselor and provider what that may cost. If the result can be determined unequivocally and that turns out to match the agreement, then client, counselor and provider are satisfied.

The argument for replacing outcome financing with input financing is that everyone then knows where they stand. After all, p and q are part of a decision. It is not mentioned that you then no longer have a grip on the desired result. That is also difficult to estimate. Because how should you choose "p" and "q" so that the intended objective/result is achieved?

Input funding (p, q) seems justified only if the relationship between (p, q) and the intended outcome is reasonably well known. That does not seem to be the case now. It seems that distrust of the provider helps motivate the choice of p*q.

Innovation on the part of the provider is not encouraged with input financing. This is better with result financing. After all, by choosing a different, cheaper, way of working with still the obligation to achieve the agreed upon result, costs can slowly start to decrease.

One argument for this change is that agreeing and measuring an "outcome" is difficult and likely to be seen as impossible. Recently, we have heard that an obligation of result in the Wmo has been banned by the courts. What is the scope of this decision?

Summary: The stated arguments for moving to a new system of financing do not convince us. Positive experiences of other municipalities with input financing may support the proposal. Therefore the question: Is there "somewhere" experience with applying input financing (p * q) in the Wmo? If so, what are the experiences with such a system?

Choosing another unproven system because the current system has limitations is not automatically good policy. It seems good only if the expected problems are noticeably less than the perceived problems with the old system.

What is your opinion of the products we have described? Do you agree with them?

We have not yet been able to answer this question properly.

Do you have any recommendations for us going forward?

1. Research and substantiate first that the new system causes noticeably fewer problems or more acceptable problems than the current system and will be allowed by the courts. If that cannot be plausibly demonstrated, then propose not this, but another system change.
2. With so many providers, it is difficult for the client and the counselor to choose. Some indication of the quality and/or clients' ratings of a provider's services provided is desirable. And from the standpoint of quality assurance, quality measurement is even necessary. The paper does not mention the evaluation of the services provided by providers. This is a omission. Our recommendation is to include an evaluation procedure, conduct it regularly and share the results with the participating municipalities. The evaluation can then be an argument for including or excluding certain providers in a new tender. It is also a valuable source of information for clients. After all, how else to choose from the 150/180 providers?
3. From a cost control perspective, it is recommended that the client also be given insight into
   the agreements made (hours AND costs), for example through a copy of the decision. This can better substantiate his image of and opinion on the expected quantity and quality of the services provided. It is then essential that his judgment is requested during an evaluation.