The Pressure on the Weakest — Statecraft

The case file that falls between three tables

In an interim assignment in the social domain of a Dutch municipality of just over one hundred thousand inhabitants, the first monthly review brought to my desk a case file that had been transferred between domains three times in four years, without anything having improved for the client. The young adult in question had a mild intellectual disability, a diagnosed autism spectrum disorder, and an unstable housing situation. In the youth-care system up to the age of eighteen he had been a “rucksack file.” At the transition to the Wmo (the municipal Social Support Act) the pedagogical perspective fell away and he entered an assisted-living trajectory. That trajectory produced increasing care needs, on which the Wmo case manager initiated a Wlz application — the Long-term Care Act — because the care intensity belonged there in substantive terms. The application was denied by the CIZ, the central indication body. Not because the care failed the Wlz criteria, but because the boundary between Wmo and Wlz here lay in a grey zone where the CIZ tests conservatively. He fell back to the Wmo. At the same time his Wajong application at the UWV (the national benefits agency) stalled, because the assessment found that he had labour capacity. The municipality had to absorb him under the Participation Act, at social-assistance level — thirty percent below the Wajong minimum-wage benefit.

In the meeting the team leader laid out the pattern without irony. Three columns, three budgets, three rejections in which the logic of each individual decision was defensible. Run such a case through the books at municipal level and the cumulative cost is no rhetorical figure. A Sheltered Living arrangement with day activities runs to roughly eighty-five to one hundred thousand euro per year for heavy target groups. Add specialised mental-health treatment for the stacked problems (three to twelve thousand), protective administration via supplementary social assistance (fifteen hundred to two and a half thousand), debt counselling (averaging just over eight thousand per case) and a Participation Act benefit of just under seventeen thousand euro per year¹. Should the case escalate to Wlz-VG7 — the heaviest intellectual-disability tariff — the rate runs up to about one hundred and sixty thousand euro per client per year². For the municipality, stacked care in this configuration runs above one hundred and twenty-five thousand euro per year; if such a person eventually does enter the Wlz, it lands at the regional care office, with the municipality still carrying supplementary social assistance and the first two years of Wmo transition support. The state itself spends nothing extra, because none of these items appears on a single national-budget line. The young adult bears the cost of his prospect of independence. He slowly comes into view as what colleagues in the corridors call a carousel case. A file that keeps spinning between tables that do not serve each other.

This is not one person and not one municipality. It is what the system does when budget fragmentation between domains is coupled to assessment criteria that are individually defensible but jointly produce a no-man’s-land between regimes. Read against the central thesis of this series, it is the reverberation on households where counterforce is absent. The budgetary logic of the central state, the UWV’s testing, municipal execution and the Wlz boundary-guards land together in one household, and the household carries the sum.

What is actually happening here

The papers in this series document what society experiences from a dissociated institutional architecture. The Illusion of Capacity described how scarcity became an institutional description that the physical reality does not justify. The Silent Expropriation described how fiscal fragmentation shifts ownership structures without anyone making the choice. The Citizen Without Recourse described how procedurally correct chains produce institutional untouchability where the citizen carries the damage. What this paper adds is the cash-flow side of that same architecture. Not ownership structure, not legal position, but the budget. Not who owns it, not who is accountable, but who pays — and who pays for who does not pay.

The thesis: budget fragmentation between columns produces perverse incentives that land selectively on households, professionals and municipalities with the least counterforce. Whoever lacks legal means to challenge decisions, whoever lacks an institutional position to enforce alternatives, whoever depends on executing organisations that are themselves under pressure, carries the sum of rational individual decisions. That is not an incident. It is how the system functions when every column guards its own budget and no one tallies the social total.

Three shifts, one pattern

From Wmo to Wlz: the vertical push-up

A municipality executing the Wmo receives funding through the general allocation from the Municipalities Fund. A client whose needs grow heavier within the Wmo can, under conditions, transition to the Wlz, which is funded from the Wlz premium via the regional care office. That is a different pot of money, a different test regime, a different executor. The experienced municipal case manager knows this and acts accordingly. Not from ill will, but because the municipal budget is the first rationality within which she accounts.

The legal precedence of the Wlz over the Wmo is no interpretation by this paper, but an incentive acknowledged by government itself. In the joint Werkagenda Langdurige Zorg (Long-Term Care Work Agenda) of the Healthcare Authority NZa, the indication body CIZ, the administration office CAK and the National Health Care Institute, dated February 2024, it is stated in so many words. The four executing organisations signal that the rising inflow into the Wlz “is partly connected with the regulation that establishes Wlz precedence over Wmo and Zvw, and thus with the incentives in the system”³. That is a remarkable document. Four executors confirm at the operational layer the mechanism that this paper documents at the system layer. Their answer is a work agenda. The legal precedence rule itself remains untouched.

The numbers are consistent with the incentive. The Wlz waiting list for nursing and care stood at just over fourteen thousand at the start of 2020, climbed to a peak of nearly twenty-three thousand in August 2022 (measured across all Wlz sectors in the NZa monitor), and on 1 January 2024 still amounted to over twenty-one thousand, with a first decline to just under twenty thousand on 1 January 2025⁴. That is not a linear rise, but a jump with a recent correction whose causes are instructive: the opening of the Wlz to the psychiatric-disorder ground per 1 January 2021, the Administrative Agreement on Mental-Health Housing of July 2024 limiting Wlz inflow on that ground to two hundred and forty per month, and the resulting drainage of the backlog that had built up in 2021 and 2022. Read honestly, the numbers do not show unidirectional rise but a system trying to repair a previous system expansion.

What remains structurally invisible in the standard accountability cycles is how large the vertical Wmo-to-Wlz flow actually is. Statistics Netherlands publishes annual customised tables in which Wmo clients in year t-1 are followed in their Wlz use in year t⁵. At municipal level those numbers exist, in absolute counts running into the hundreds per year for the larger cities. At national level no body publishes a closed total of pure Wmo-to-Wlz inflow. An order-of-magnitude estimate based on the public custom tables suggests that somewhere between twenty-five and thirty-five percent of Wlz inflow is preceded by a Wmo trajectory. That is a substantial share for which no annual figure is produced at national aggregate level. The CIZ reports for 2024 a rejection rate of eleven percent on Wlz applications, a percentage that has barely shifted since 2019⁶. The gatekeeping function does not change, but the volume of applications does.

This is not what the municipal executor wants. In conversations with Wmo case managers in several municipalities, also far beyond my own assignments, I hear the same frustration. They want to organise appropriate care. They know the client is best served by continuity. But the structure within which they work asks them to guard the budget of their own domain. When a client is going to cost two hundred thousand euro a year, while the Wlz could absorb him for less, the push-up pressure is no longer an individual choice but a system question. The rationality lies at organisational level. The damage lands on the client and the care chain.

Wajong as a closing-down regime: the one-way door

Since the Participation Act of 2015 the Wajong has been closed to new inflow⁷. Anyone who became disabled-from-youth after that date and who has labour capacity ends up in the municipal Participation Act, at social-assistance level. Anyone who already had Wajong status before 2015 keeps it in principle, but operates within a statutory regime that is being wound down as a whole. The Wajong is therefore, in policy terms, a closing-down regime: a scheme that has cut off inflow and lets the existing population die out, typically through outflow to work, to state pension or to the Participation Act.

The UWV figures at end-2024 tell that closing-down precisely. The Wajong stock counted 246,850 active benefits at that moment, of which just over 103,000 were in the closed regimes with labour capacity and just over 143,000 in the regime “permanently no labour capacity,” which now only sees internal mutation. The stock is paradoxically stabilising: 248,700 is forecast for end-2025, a small rise that does not stem from new inflow but from declining outflow to state pension and death⁸. Labour participation among Wajongers with labour capacity stood at 51.0 percent in regular employment in 2024, virtually identical to 50.4 percent in 2019. The absolute number of working Wajongers fell from just over fifty-five thousand in 2022 to nearly three thousand fewer by 2024. Among non-working Wajongers with labour capacity, seventy-six percent had not worked for three years or more in 2024, against seventy percent in 2020⁹. Inactivity is hardening. The policy that was supposed to break it is the Wajong Simplification Act of 2021.

The benefit-level difference between Wajong and social assistance is material. A Wajong benefit at labour capacity sits at seventy percent of the statutory minimum wage. A social-assistance benefit, depending on living situation, sits about thirty percent below that¹⁰. For two citizens with comparable disabilities the system therefore produces an existential income gap that depends solely on the year in which they entered a benefit. That gap is in itself a first form of reverberation: the same disability, the same degree of labour capacity, a different benefit position, because the law happened to take effect on a different date.

The sharper reverberation, however, is not in the income gap but in the one-way door that characterises the closing-down regime. A sitting Wajonger with labour capacity who considers accepting a job does not look primarily at the wage difference. He looks at what happens if the job does not last. The Wajong Simplification Act of 2021 made formal repairs at this point: the period within which a Wajonger can fall back on the Wajong upon increased disability has been extended from five years to retirement age, and the rule that earning a year of self-supporting minimum wage automatically results in status loss has been scrapped¹¹. On paper the door is open both ways again.

In practice the system does not work that way. The evaluation remains conspicuously empty on the most crucial point. In the third monitoring report of 16 April 2025, in the implementation test of July 2023, in the experience study among the target group, in no UWV annual report since 2021, is the number of submitted or granted reactivation requests published. The statutorily extended reactivation period — one of the three core measures of the Act — is not quantitatively evaluated¹². This is no coincidence. It is, in the terms of The Citizen Without Recourse, the pattern that government does not evaluate its own core measures when evaluation would render the design uncomfortable. The state secretary acknowledges in the same report that on the basis of the figures “it cannot be said whether the Wajong Simplification Act has had any influence on the percentage of Wajong recipients in work,” and that the Banenafspraak (the negotiated jobs scheme) “creates little to no extra opportunities for people with a Wajong benefit”¹³. The statutory safety net exists. The institutional certainty beneath it has not been measured.

The effect is a population that can formally work and actually wants to work, but does not move, because the risk of definitive loss of a more favourable benefit position weighs heavier than the potential return of an employment trajectory that is still uncertain. This is no individual rationality failure. It is a collective and predictable response to a system whose design direction is institutional wind-down, while the accompanying repairs at individual level are not delivered through credible execution. The Netherlands Labour Inspectorate found in July 2024 that thirty-one thousand of the ninety thousand Wajongers in the Banenafspraak did not work at all and that the target of one hundred and twenty-five thousand jobs by 2026 is unachievable under unchanged policy¹⁴. A Regioplan study evaluating the Wajong benefit reduction from seventy-five to seventy percent of minimum wage, introduced from 2018 onward, concludes in the same vein: the income incentive had virtually no effect on labour participation¹⁵. The assumption that a lower benefit activates failed against empirical reality. For people in vulnerable positions, finding work is not a matter of financial motivation but of access, support, health and stability. Both interventions — the inflow closure of 2015 and the benefit reduction of 2018 — illustrate the same pattern: a policy intervention that looks defensible at system level but misjudges the behavioural response of the target group, because it never engaged the target group as an acting subject in the design.

Here the pattern of this reverberation emerges clearly. The Wajong architecture has been wound down without a replacement structure being delivered that protects the people for whom the Wajong was intended in a comparable way. The municipality received responsibility for the younger inflow, the income gap was accepted, and sitting Wajongers were placed in a closing-down regime they can only leave through a one-way door. For the municipality this is an outcome thirty percent cheaper per new case than under Wajong financing. For the central state it is a declining Wajong budget on plan. For the young adult with a mild intellectual disability who works or wants to work, it is an institutional trap that pushes him into stasis. Three losers in one architecture, with the system-level outcome that the Wajong population shrinks not through successful activation but through the absence of successful activation.

Youth care: system responsibility without execution

The third file is the most clearly documentable example. Since the decentralisation of 2015, municipalities are responsible for the execution of youth care. The state retains system responsibility. The numbers tell the rest. The Improven Final Report on Youth-Care Spending 2023 and 2024, commissioned by the Ministry of Health and published in November 2024, provides the basic figures. Total municipal youth-care spending was 6.5 billion euro in 2022, rose to 7.2 billion in 2023 (eleven percent growth) and was projected at 8.1 billion for 2024 (twelve percent growth). Against the multi-year financial framework agreed between the Ministry and the Association of Netherlands Municipalities, this means a deficit of 628 million euro in 2023 and 828 million in 2024, cumulatively almost 1.5 billion in two years. Client volume grew from around 380,000 youth in 2015 to nearly 473,000 in 2024¹⁶. Average duration of non-residential youth care rose from 290 days in 2015 to 406 days in 2023.

The Expert Committee Hervormingsagenda Jeugd (the Van Ark Committee) published Growing Pains, its interim advice on the Youth-Care Reform Agenda, on 30 January 2025. The committee held that the savings target of one billion euro from 2026 onward is “unachievable” and used 7.7 billion euro as a 2024 reference for future indexation¹⁷. In the 2025 Spring Memorandum the cabinet allocated three billion euro extra over the years 2025 to 2027, with an additional 728 million euro to compensate deficits over 2023 and 2024¹⁸. The direction of the cash flows points unambiguously: municipalities are running aground, the state tops up, and the Reform Agenda promises measures meant to limit spending without fundamentally changing the architecture that drives the spending.

The average Dutch child entering youth care is in practice followed by around twelve organisations: the school, the family doctor, the neighbourhood team, the youth doctor, a specialist mental-health provider, possibly an orthopedagogical treatment centre, a certified child-protection institution, a foster-care provider, a municipal area team, a compulsory-education officer, sometimes a youth protection officer, and in complex cases a domestic-violence safety service. Twelve coordination nodes, twelve files, twelve separate accountability cycles. The agreements to reduce this through case management, multidisciplinary consultation and youth-care regions exist for good reason, but every new coordination layer adds a node rather than removing one.

In an interim assignment as cluster director for the social domain, where the starting point was a structural youth-care overrun of three to four million euro on a budget of around one hundred million, what I found in the first thirty days was that the budget was not so much insufficient as it was unsteerable. Waiting lists of ten weeks, a fifth reorganisation in six years, an outgoing director leaving the organisation bruised, and professionals doing their work but no longer able to make sense of its financial outcome. The intervention diagnosis pointed, in the terms of the Handbook, to all three corners of the Strategic Triangle simultaneously. But the core lay in a type of cost-shifting imported from outside the municipality: providers becoming more expensive on average because their case complexity rose, because lighter cases stopped flowing in due to tariff pressure while the more complex ones still did.

What the municipality then actually did was become more mature in procurement, contract more strictly, centre case management at the area teams and renegotiate the annual budget with providers. All workable interventions within municipal responsibility. What none of those interventions could touch was the actual distribution of resources between state and municipality, the volume of referrals from family doctors over which the municipality has no steering instrument, and the fact that the Youth-Care Reform Agenda did not reduce execution pressure proportionally to the rationalisation expectation. The systemic cost-shifting from state to municipality, dressed up as decentralisation, lay outside the cluster’s reach.

This is what the outline of this paper means by system responsibility without execution. The state retained the authority to set rules, monitor norms, sign reform agendas and top up budgets when deficits became politically unavoidable. The municipality received execution, the waiting-list risk, the reputational risk, and increasingly the cost. Who is held accountable nationally is, three ministers later, no one. Who is held accountable municipally is an alderman with a sealed budget and a council elected on cost-of-living concerns. The reverberation of that architecture lands in the waiting room of a mildly intellectually disabled client or an autistic fourteen-year-old waiting ten weeks for a suitable place.

In all three files the mechanism is comparable. An individual measure with a defensible rationale is taken by one government layer. The cost impact falls asymmetrically across columns or government levels. The party absorbing the cost lacks the instruments to break the incentive. The budget shifts, the execution shifts, accountability fragments, and the client or young person who has to move through the system carries the combinatorial damage. This is the same mechanism The Silent Expropriation described for ownership structure. There capital shifts from private to institutional without anyone making the choice. Here the care load shifts from state to municipality, from Wajong to social assistance, from Wmo to Wlz, equally without anyone making the choice.

The difference lies in where the damage lands. The silent expropriation lands on households with private wealth that contracts. The pressure on the weakest lands on households without wealth, without legal apparatus, without formal system position, without organisational counterforce. That is what selective incidence means. Not that the system wilfully discriminates. Rather that the architecture is so designed that damage flows along the paths of least resistance, and those paths run predictably through households with the least capacity to correct.

The measurement vacuum: three schemes that do not evaluate themselves

In writing this paper a pattern emerged that is sharper than the individual files. Three of the four schemes discussed here do not, or only partially, evaluate their own core measures. The Wmo-to-Wlz flow is not published as a national aggregate by any institution, although the underlying CBS data are available at municipal level. The number of reactivation requests under the Wajong Simplification Act has not been recorded in public evaluations since the act came into force in 2021, even though the lifelong reactivation period is one of three core measures. The causal share of border-Wlz clients in municipal Wmo overruns is not quantified by any research institute, despite being a first-order question for the social domain. With youth care the situation is different: there measurement is in order (Improven, Van Ark, CBS Youth Monitor), but the causal contribution of architecture to the deficits is politically not recognised as an evaluation object.

These data gaps are no oversights. They are the external symptomatology of precisely the dissociated government organisations this whole series documents. There is no party whose interest it is to measure the flow. The Ministry of Health has no interest in a hard figure on how much Wlz inflow comes from Wmo, because the mechanism would then become a topic on which the Ministry is accountable. The Ministry of Social Affairs has no interest in a hard figure on Wajong reactivation requests, because a low figure would demonstrate that the statutory repair is ineffective. The Ministry of the Interior has no interest in a hard figure on border-Wlz cases in Wmo overruns, because that would demonstrate that the general allocation does not cover real execution costs. CBS supplies what commissioners ask for. Research institutes supply what ministries fund. The sum of this is that the measurement vacuum reproduces itself simply by having no budget holder who wants to fund the measurement.

The financial architecture producing this is divided across departments that each operate their own indicator set. Health measures Wlz spending, Wlz waiting lists, average care intensity per client, throughput times, average tariffs. Social Affairs measures Wajong inflow, Wajong outflow, Participation Act inflow of disabled-from-youth, employment participation per category. Interior measures municipal budget outcomes, the general allocation, specific allocations, the “ravine year,” municipal reserves¹⁹. Finance measures the State Budget, the funds, the spring memoranda. Statistics Netherlands measures health spending as a percentage of gross domestic product²⁰.

What none of these meters measures is the household-level total. Not what a household within which three columns are simultaneously active actually goes through in care contacts, benefit mutations, indication decisions, decisions, reassessments and amendments in a year. Not what the financial differences are between citizens with comparable disabilities entering the benefit schemes in different years. Not what share of Wlz growth originates from Wmo flow incentivised by budget pressure. Not what share of Participation Act inflow of disabled-from-youth represents reclassifications that under the old Wajong criteria would have turned out differently.

These blind spots are not incidental. They are the sum of how the departmental accountability cycle is organised. Each ministry accounts for its own budget article. The Central Planning Bureau tests macro-projections. The Court of Audit tests legality and efficiency within articles. No one in the current architecture has the position, the authority and the instruments to measure the household consequences of the combined columns architecture as an independent policy product.

This is no oversight but a design choice. The choice to lodge indicators per column flows from the logic of political accountability: a minister wants to be held accountable for her own budget article, not for effects in other domains where she has no instruments. The mobility of senior civil servants under the General Senior Civil Service regime, in the terms of Restoration State Netherlands²¹, reinforces this through the absence of long-term ownership that could look across columns. Whoever is held horizontally accountable for what is vertically divided falls outside every politico-administrative instrument. The measurement vacuum is the natural outcome of an architecture that has designed no function for the one who must see the sum.

Diagnosis through the Strategic Triangle

For those who use Mark Moore’s Strategic Triangle as analytical compass, this file is an instructive example of how a problem whose three corners do not visibly seem out of balance can nevertheless, in composition, be fundamentally out of balance.

The public value would be that a household with multi-problem complexity has access to appropriate support, at a level that maximally promotes independence, with continuity across life stages. No one in the system will dispute this public value. Everyone underwrites it in mission statements and college programmes. But the operationalisation differs per column. Health reads public value as access to Wlz care within waiting-time norms. Social Affairs reads public value as labour participation. Municipalities read public value as integral support within available budget. The values look alike but produce contradictory execution decisions as soon as a client moves through several columns at once.

The operational capacity is reasonably secured per column. The CIZ can test Wlz access. The UWV can assess Wajong applications. Municipalities can execute Wmo and Participation Act. Providers can deliver youth care. None of these chains functions perfectly, but none is structurally ungovernable within its own domain. What is missing is operational capacity for the cross-column file. There is no chain regulator, no integral decision authority, no budget holder who can redistribute across the three columns. Operational capacity falls neatly within the silos and predictably falls away on the seams between silos.

The political legitimacy is divided across government levels each with their own mandate. The Minister of Health builds political legitimacy by keeping Wlz spending manageable. The Minister of Social Affairs builds political legitimacy by raising labour participation. The alderman for the Social Domain builds political legitimacy by limiting waiting lists and guarding the budget. The municipal council confers political legitimacy on choices within the municipal domain. The House of Representatives confers political legitimacy on system choices within the state domain. None of these legitimacy sources is fit to ratify a redistribution between columns, because none of them recognises the cross-column file as its own mandate.

The Strategic Triangle does not point here to a missing corner, but to a geometry that as a whole does not close. The three corners each lie in their own plane. Whoever wants to bring the system into balance must not strengthen one corner but bring the triangle back into one common plane. At the level of a household with multi-problem complexity, that is not possible without structural revision of who owns the entire life domain.

In the terms of De Caluwé and Vermaak’s Change Colours this means that the dominant intervention in Dutch public administration — blue planning thinking through budget discipline and reform agendas — predictably falls short here. What the problem requires is a combination of yellow (redistribution of power across government levels) and white (room for execution professionals and municipalities to organise outside the existing architecture what cannot be organised within). The current debate on the Youth-Care Reform Agenda — predominantly blue with yellow resistance — therefore lacks the colour the problem actually demands.

The Scandinavian contrast: how it can be different

In the Dutch policy debate, references to Scandinavia as alternative recur regularly, with the same reflex with which any comparison to our scale is dismissed: Denmark and Sweden are smaller, have fewer municipalities, and their model does not translate to Dutch proportions. This argument is empirically untenable. Denmark counts ninety-eight kommuner since the 2007 Strukturreformen, with an average size of about sixty thousand inhabitants. Sweden counts 290 kommuner with an average of about thirty-six thousand. The Netherlands counts 342 municipalities with an average of about fifty-three thousand. Dutch municipalities are roughly the same size as Danish ones and larger than Swedish ones²². Scale does not explain the difference. The architecture of ownership does — combined with a central risk-dampener and a binding interpretive authority. Three design choices the Netherlands did not make in 2015 and that Denmark introduced as a coherent package in 2007.

Denmark: one government layer, central refusion, binding interpretive authority

The Strukturreformen Denmark introduced on 1 January 2007 was not only about reducing 271 kommuner to ninety-eight and thirteen amter to five regioner. It was about lodging ownership. Social services, youth care, elderly care and disability support were almost entirely placed at kommunal level. The regioner received a supplier role for the most specialised facilities. The state retained the legislative function and upstream coordination through the Socialstyrelsen. What Denmark designed alongside this is what the Netherlands should have designed in 2015: an integrated kommunal owner of the social domain, with two instruments that keep the design workable.

The first instrument is the central refusionsordning under section 176 of the Serviceloven, applied since 1 January 2024 also to the Barnets Lov (Act on the Child). When a kommune accumulates per-person spending exceeding a threshold within a year, the central state refunds a progressively rising share of the excess. Above 0.83 million DKK the kommune gets back twenty-five percent, above 1.63 million fifty percent, above 2.05 million seventy-five percent. There is no hundred-percent reimbursement: the kommune structurally bears at least twenty-five percent of every krone above the highest tier²³. Thresholds are indexed annually. For multi-child families with heavy care, expenditures are aggregable. Since 2021, submission is monthly rather than annual, providing risk-dampening at cash-flow level.

The effect of this design is threefold. The own-risk component prevents moral hazard: the kommune retains an incentive to control costs, because every krone still costs it at least a quarter. The progressive risk-dampening keeps heavy individual cases manageable, also for small kommuner. And the file stays with the same executor. No Wmo-Wlz boundary arises, no shifting between budget holders. This is fundamentally different from a Wlz indication in the Netherlands. In Denmark only the financing mix between kommune and state changes. In the Netherlands the execution mandate itself shifts — and with it the incentive to push up.

The second instrument is the Ankestyrelsen, the Danish central appeal and interpretation body that combines four functions in one institution: complaint handling of citizen against kommune, binding principafgørelser that form de-facto jurisprudence for all ninety-eight kommuner, kommunal- og regionstilsyn on legality, and annual publication of omgørelsesprocenter (overturn rates) per kommune — the so-called “Denmark map.” Since 2022 high overturn rates trigger a mandatory action plan in the kommunalbestyrelse. The Dutch counterpart is dispersed across the Central Appeals Tribunal, municipal objection committees, the National Ombudsman and the Association of Netherlands Municipalities. None of those bodies has binding interpretive authority within one regulation domain, and none of them produces a per-municipality comparison that generates political pressure to correct execution. Consequently 342 Dutch municipalities drift toward 342 different interpretations, while ninety-eight Danish kommuner are held to one binding line. This explains why execution fragmentation in Denmark remains manageable at a scale that in the Netherlands leads to legal inequality.

The Barnets Lov, which entered into force on 1 January 2024, refined the system within this kommunal structure without activating other government layers²⁴. Substantively: the child obtains party status from age ten (was twelve), stricter timeframes for the børnefaglig undersøgelse (specialist child-welfare assessment), one integrated regulatory system for both disability and child-welfare cases. No revision of ownership, no new coordination layer, no new collaborative structures between kommuner. This is a precedent the Dutch debate ought to mark. Reflex calls for reorganising the administrative division of labour can be parried by pointing out that a comparable specialised-domain reform in Denmark was carried out within the existing architecture. Not because the Danes are conservative, but because their architecture can carry the reform.

The same applies to elderly care. Hjemmehjælp (home help) and plejebolig (nursing housing) fall under the Serviceloven (from 1 July 2025 under the new Ældreloven) and are both kommunal²⁵. There is literally no second budget holder to which cost-shifting can occur. Lighter and heavier care fall under the same regime, with the same budget holder, the same gatekeeper and the same executor. Between kommune and region there does exist a targeted negative incentive: kommunal full-funding of færdigbehandlede patienter (patients whose specialist treatment is finished) forces municipalities to internalise the costs of hospital admissions of their inhabitants. From 1 January 2025 onward the wider kommunal co-financing of specialist hospital care is being abolished — an interesting signal that even Denmark deems activity-dependent cross-financing not worth the bureaucratic effort. The direction is clear: fewer cross-flows, more integral ownership.

Sweden: one integrated regime, with one instructive exception

Sweden has one integrated kommunal regime for youth care (the Socialtjänstlag, renewed on 1 July 2025) and the Lag med särskilda bestämmelser om vård av unga for involuntary placement. Elderly care is fully kommunal. But one important exception offers an instructive lesson: in personlig assistans under the Lag om stöd och service till vissa funktionshindrade (LSS), the kommune funds up to twenty hours of basic needs (grundläggande behov) per week, and above that the state pays through the Försäkringskassan²⁶. Since around 2008 the Försäkringskassan has applied an increasingly strict interpretation of the concept grundläggande behov, confirmed by the Supreme Administrative Court in 2009 and 2012. The number of persons with state assistansersättning fell from over sixteen thousand in 2008 to under thirteen and a half thousand in 2022. Those falling below the threshold remain entitled — but at the kommune. The Inspectorate for Social Insurance reported as early as 2014 systematic cost-overflow from state to kommune.

This is usable as negative evidence for the thesis of this paper. Even a country with a well-organised welfare state develops cost-shifting pathology as soon as a second budget holder with an activity threshold is introduced. The Netherlands has this pattern multiplied by four: between state and municipality in youth care, between municipality and regional care office in Wmo-Wlz, between state and municipality in Wajong–Participation Act, and between state and municipality in sheltered housing. The Swedish lesson is that the problem is not decentralisation versus centralisation, but the design of the financing couplings. Wrong couplings produce the same pathology everywhere in the world.

Norway and Finland: warnings against reflex

Norway introduced the Samhandlingsreformen in 2012, with twenty percent kommunal co-financing of specialist care and a daily fee for ferdigbehandlede pasienter who were not collected by the kommune. The intended effect was that kommuner would invest in primary care to prevent expensive hospital care. The actual effect was that kommuner shifted clients to private rehabilitation clinics that fell outside the cost-sharing scheme. The co-financing was abolished in 2015. Finland restructured in 2023 with the sote-uudistus, with twenty-one hyvinvointialueet (wellbeing services counties) taking over health and social care plus fire services from about three hundred and nine kommuner, fully state-funded²⁷. Early analyses from 2024 signal that the incentive structure between kommune and wellbeing region for prevention is not yet fully developed. The lesson for the Dutch debate: careful design of the incentive structure is at least as important as the allocation of ownership. Wrong incentives can also arise within one-tier systems, and wrong restructurings can cost years of good policy energy without removing the original pathology.

What this means for the Dutch task

Three design features make the Danish system workable: integral ownership at one government layer, a tiered central refusion as risk-dampener, and a binding interpretive authority that corrects legal inequality between kommuner. None of these three features exists in the Netherlands in comparable form. The 2015 decentralisation delivered the first, partially, but without the second and the third. The result is what this paper documents: cost-shifting between budget holders without a central risk-dampener, with 342 different interpretations without binding interpretive authority. The Swedish lesson adds that a second budget holder with activity threshold always generates cost-shifting, regardless of other institutional design. The Netherlands does not have one second budget holder with activity threshold, but at least three simultaneously. Whoever derives from this that the Netherlands should move toward a Danish or Swedish model need not agree on the exact end state. The analytical point is one step more conservative: without central risk-dampener and without binding interpretive authority, integral ownership at a lower governmental level is institutionally untenable.

The Aiki test at system level

The Aiki Method, developed in the Handbook as a method for personal mastery under pressure, calls for the same principle in another form at system level. Do not force where the counterforce is greater than one’s own force. Do not try to override the incentives in the architecture by laying yet another coordination layer on top. Do redirect the incentives by adjusting the architecture so that the natural energy of the system flows toward the collective interest rather than away from it.

Concretely: instead of forcing government layers not to push up to the Wlz, design the system so that pushing up no longer profits the pusher. Instead of trying to activate sitting Wajongers through tightened rules in a closing-down regime, design the system so that the one-way door disappears: comparable benefit position for comparable disabilities, irrespective of application year and with a reactivation route whose execution is so reliable that sitting beneficiaries do not have to see the step toward work as institutional loss. Instead of building up the Youth-Care Reform Agenda as a coordination apparatus above municipalities that cannot carry execution, design the system so that the government layer holding the integral life domain also captures the cost-saving from preventive investment, and bears the financial burden of late escalation.

This is not the same as marketisation, and not the same as performance-based financing. It is what orthodox public administration calls integral responsibility at one government level, and what the Aiki Method at system level would recognise as following energy rather than fighting it. The systemic incentive structure is stronger than any regulatory density laid upon it. Whoever governs in that system can either use it for the goal or fight it at the cost of the goal. There is no third option.

What the reverberation means

The cumulative outcome of budget fragmentation between columns is that households with the least counterforce carry a disproportionate share of system invisibility. Concretely:

The young adult with mild intellectual disability and autism circling between Wmo, Wlz and Participation Act bears a thirty percent income gap relative to those who entered the old Wajong earlier, and bears a care-continuity break at every column transition. The sitting Wajonger still under the old scheme bears the one-way door of the closing-down regime: movement is institutionally penalised, standing still institutionally rewarded. Both bear the effect of an architecture that does not grant them a single owner.
The child in youth care waiting ten weeks for specialised help bears a waiting time exceeding average execution capacity, while a Reform Agenda states this should not be allowed. The municipality can shorten the waiting time within the existing budget only by giving up elsewhere. The giving up lands elsewhere — in other waiting times, other indication decisions, other rejections.
The Wmo client steered toward the Wlz but whose flow the CIZ refuses, remains hanging in the Wmo budget against a cost price exceeding the regular Wmo offering. The municipality loses. The Wlz wins, in its own terms, because it has rejected an application. The client loses, because continuity and specialisation bite each other.

These are no anecdotes from one municipality. These are the empirically documentable outcomes of an architecture that has no place for the household-level total. The reverberation is that the group with the least capacity to develop an individual path between the columns structurally receives a less favourable path than comparable groups would have received in the past, or than comparable groups receive in other countries.

Action perspective

The action perspective follows the direction outlined at high level in Restoration State Netherlands, and concretises it for the reverberation on households. The Scandinavian contrast does not deliver a ready-made solution, but it does deliver three design principles that can each be introduced separately in the Netherlands.

One budget holder per life domain, at the level that carries execution capacity. Make one government layer responsible for the entire care and support domain of a household, rather than per scheme. For the income domain that level lies with the central state: Wajong, WIA, social assistance and tax credits under one budget holder, possibly through an integrated execution organisation along Danish lines, in which the minister is directly accountable for execution outcomes. For the care and support domain — including youth care, Wmo and Wlz — the level does not lie with the individual municipality. The 2015 decentralisation has empirically shown that most of the 342 municipalities lack the scale for procurement, contract management, quality monitoring and the specialised facility architecture the integral life domain demands. The administrative level that can hold ownership and execution capacity in one hand lies higher. Three options are conceivable. The first is the existing youth-care region with its own administrative mandate as integral budget holder, replacing the current hub-and-spoke municipal ownership with a coordinating joint-regulation layer above. The second is the province with built-up execution apparatus in the social domain, comparable to the role provinces have historically played in other domains. The third is the central state in full re-centralisation along Danish or Swedish lines, with direct ministerial accountability for execution outcomes and an end to the fiction that system responsibility without execution is workable.

Each of these three options is politically heavily encumbered. None of these options is seriously on the table in the current debate. What they share is the recognition that ownership and execution capacity must coincide at one government layer, and that the current distribution — ownership (municipality) versus execution capacity (fragmented across youth-care regions, regions, joint regulations and providers) — is precisely the problem this paper documents. Push-up disappears the moment the pot is the same, provided the organisation managing the pot can also carry execution. That requires revision of the Youth Act, the Wmo, the Wlz financing structure, the joint-regulations architecture and the Participation Act — all five not impossible but each politically encumbered by their own coalitions and execution frameworks.

A central risk-dampener for heavy individual cases, along Danish lines. Between the current decentralisation and full re-centralisation lies a design principle that does not yet exist in the Netherlands: a tiered state reimbursement for spending above a per-client per-year threshold. For youth care, for Wmo and for the heaviest Wlz cases, modelled on section 176 of the Danish Serviceloven. A threshold around one hundred thousand euro per client, with twenty-five percent state reimbursement between one hundred thousand and two hundred thousand, fifty percent between two hundred thousand and three hundred thousand, seventy-five percent above three hundred thousand. This is administratively feasible through monthly reporting to an execution body, comparable to the current BUIG system in the Participation Act. The effect is threefold: small municipalities are not knocked over by individual cases, the incentive to push up to the Wlz disappears for the heaviest cases, and the financial interest of the municipality in investing in prevention remains intact because every euro invested still yields its full return at lighter cases. This would be new for the Netherlands on the income side, but well embeddable within the existing VAT compensation fund and specific allocations toolkit.

A binding interpretive authority and public per-municipality comparison, along Ankestyrelsen lines. The Central Appeals Tribunal, municipal objection committees and the National Ombudsman together do not form a functional equivalent of the Danish Ankestyrelsen. What is missing is a body that produces binding interpretations within one regulation domain and annually publishes a per-municipality comparison of rejection rates, throughput times and the percentage of upheld objections. Such a body would not punish municipal action but make it transparent. The current National Ombudsman has impulses in this direction but lacks the binding interpretive function. An expansion of its mandate, or a new body with that role explicitly, fits with what The Citizen Without Recourse documented about procedural untouchability in the current execution chains. Not more legal protection, but one place where what 342 municipalities interpret separately is consolidated.

Compensation duty on cross-domain shifting. For the transition period in which life-domain responsibility is not yet integrally lodged, introduce a compensation duty. When a government layer pushes a file into another pot and thereby causes net costs elsewhere, it bears those costs itself. Operationalisation requires an arbiter function between state and municipalities, comparable to the position of the Ministry of Finance in inter-administrative relations, but with explicit mandate to test individual cost-shifts. This is administratively heavy but renders the current perversity visible in the accounts where it now disappears.

An independent total-meter. Lodge the measurement of household consequences of the fragmented schemes with an independent institute, comparable to the Netherlands Institute for Social Research (SCP) but with explicit authority to combine all columns at household level. This institute produces an annual State of the Reverberation: a report on the actual outcomes at household level of the cumulative regulation architecture. The institute does not advise on policy but renders visible the total now structurally absent. Concretely: this institute publishes the national total of Wmo-to-Wlz inflow, the number of Wajong reactivation requests since 2021, and the share of border-Wlz clients in municipal Wmo overruns. Three figures now structurally absent — and whose absence is itself the evidence of why the measurement is needed.

Strategic Triangle test on reforms. No substantive change to the financing architecture of a social domain without an explicit test on all three corners of the Strategic Triangle, with attention to cross-column effects. This is a procedurally small instrument but methodically powerful: it forces the legislator to substantiate explicitly the assumption that a column change confines itself to one column. In the Youth-Care Reform Agenda, in the Participation Act and in Wlz decision-making, such a test is now materially absent.

None of these interventions is revolutionary in itself. Together they form a different pattern of governance, in which the household-level total no longer falls outside view by definition. It is therefore a shift away from the type of intervention Dutch public administration is traditionally good at — blue planning combined with yellow political negotiation — toward a type at which it is less good: a yellow-white-red combination of redistribution, room for execution, and attention for who carries the total.

Connection and placement

This paper is the fourth in the Statecraft series Reverberation (Reverberation). The Illusion of Capacity documented the reverberation on physical space. The Silent Expropriation documented the reverberation on ownership structure. The Citizen Without Recourse documented the reverberation on individual legal position. The Pressure on the Weakest documents the reverberation via the cash flows between budget holders. Then follows The Vanishing Fabric on community, and the two signature essays Blind to a Known Future and Lagging Behind the Speed close the pattern with the synthesis piece The Frozen Zeitgeist.

The action perspective of this paper aligns with the direction Restoration State Netherlands takes: restore ownership, render cost-shifting impossible, reintroduce long-term responsibility. In chapter 13 of De Richting van de Beweging (the forthcoming book) I work out the youth-care interim assignment as a case, with the Strategic Triangle as diagnostic instrument and the Change Colours as intervention grammar. What that chapter places at practice level, this paper places at system level. Whoever works within a municipality on youth-care overruns can achieve results with a well-organised interim approach. Whoever works outside the municipality on the architecture that makes the overruns predictable finds no institutional place where that work can be addressed. The Handbook describes the craft. This paper describes the architecture the craft is asked to transcend.

The cumulative reverberation of these patterns — on physical space, ownership structure, legal position, financial centre of gravity and community — is what The Frozen Zeitgeist will try to document as the aggregate state in which Dutch society now experiences itself. This paper is one of the pieces of evidence for that diagnosis. The pressure on the weakest is no anecdote from the social domain. It is the most empirically visible form of what a fragmented institutional architecture structurally produces: damage that lands predictably where counterforce is lowest.

Whoever takes the Aiki proposition of the Handbook seriously knows what Statecraft’s positioning here must be. Not flowing along with the incentives that produce this damage. Not fighting an architecture stronger than any individual resistance. Rather, doing the work of redesigning the architecture itself so that the natural energy of the system flows toward the collective interest. That is no quick fix. That is statecraft.

Colophon

Jacob Huibers is an interim manager with over twenty years’ experience in the Dutch public sector. He has worked as cluster manager, cluster director and quartermaster at municipalities ranging from fifty thousand to over two hundred thousand inhabitants, and at regional collaborative bodies, particularly in the social and physical domains. Statecraft is his platform for strategic reflection on public execution. The book De Richting van de Beweging: Interim-Management in de Publieke Sector (The Direction of the Movement: Interim Management in the Public Sector) is in preparation (manuscript 2026).

This paper is the fourth in the Statecraft series Reverberation (Reverberation), to appear in 2026 and 2027 in eight parts. The previous parts are The Illusion of Capacity (20 April 2026), The Silent Expropriation (21 April 2026) and The Citizen Without Recourse (22 April 2026). The forthcoming parts are The Vanishing Fabric, Blind to a Known Future, Lagging Behind the Speed, and the synthesis piece The Frozen Zeitgeist.

Statecraft, April 2026.

Footnotes

¹ Tariffs 2024-2026 based on published municipal product codes (Amersfoort Sheltered Living arrangements 1-3 incl. day activities approximately €58,800 to €99,130 per year; Sheltered-at-Home approximately €11,000 to €35,200), the NVVK-Divosa benchmark for debt counselling (€8,121 per case, 2024), Stimulansz on protective administration (private trustee approximately €883/year, professional regular €1,515/year, debt-administration €2,107/year in 2026), and the Participation Act social-assistance norm 2026 (single, 21+: €1,401.50/month including holiday allowance). The final calculation is an arithmetical reconstruction based on public component tariffs; no published integral figure exists for “stacked care young adult MID+ASD” — a methodological point the Interdepartmental Policy Investigation MID (Ministry of Finance/SCP, 2019) itself acknowledges.

² NZa Wlz tariff regulation 2024 (BR/REG-24123 ZZP/VPT 2024); maximum tariff VG7 (intellectual disability with severe behavioural problems) approximately €160,000 per client per year for residential care with treatment, with VWS-allocated supplement of €40 million per year for 2023 and 2024 due to under-funding.

³ Netherlands Healthcare Authority NZa, Care Indication Centre CIZ, Central Administration Office CAK, and National Health Care Institute (Zorginstituut Nederland), Werkagenda Langdurige Zorg (Long-Term Care Work Agenda), 20 February 2024. The cited passage is a direct government acknowledgement of the incentive structure this paper documents. The four organisations signal that the rise in Wlz inflow connects to the legal precedence of Wlz over Wmo and Zvw, and formulate a work agenda to “review the precedence of Wlz.” The legal precedence rule itself remains untouched in the work agenda.

⁴ ZN/Zorginstituut Nederland, National Reports on Long-Term Care Waiting Lists (Wlz) Q1 2020 through Q1 2025; NZa Accessibility Monitor (all Wlz sectors). V&V (nursing and care) figures per 1 January: 14,565 (2020), peak 22,200 in 2023, 21,762 (2024), 19,971 (2025). The broader NZa monitor across all Wlz sectors registered the overall peak of 23,497 waiting in August 2022. Methodological break per 1 January 2021: Zorginstituut Nederland replaced the old waiting statuses (Active/Non-active) with four new statuses, requiring care when comparing 2020 with 2024.

⁵ Statistics Netherlands (CBS), Wmo Clients in 20xx with Wlz Use in 20xx+1: Age, Gender and Income, custom tables 85038NED (year 2020), 85310NED (2021), 85594NED (2022), 85985NED (2023) and 86154NED (2024, provisional). A closed national aggregate of pure Wmo-to-Wlz inflow is not available as a publication; only at municipal level. Example Amsterdam: 2,530 new Wmo-to-Wlz entrants in 2021, 2,040 in 2022. Example Rotterdam: 2,175 in 2021, 1,920 in 2022. Own extrapolation to national level: 25 to 35 percent of Wlz inflow has a preceding Wmo trajectory.

⁶ CIZ, Annual Document 2024, April 2025; 143,998 applications received, 130,630 decisions, 89 percent positive, 11 percent rejected. The rejection rate has been almost stable since 2019, despite growing application volume. Objections in 2024 rose by 17 percent against 2023, with the Wajong/mental-health ground over-represented.

⁷ The Wet werk en arbeidsondersteuning jonggehandicapten (Wajong: Work and Support for Disabled-from-Youth Act), substantially amended at the introduction of the Participation Act per 1 January 2015. Since then the Wajong is only accessible for disabled-from-youth without sustainable labour capacity.

⁸ UWV, Annual Report 2024 and Volume Developments Autumn 2024 (UKV 2024-10). Stock 246,850 active benefits at end-2024, forecast 248,700 for end-2025. Growth of the “permanently no labour capacity” group between 2020 and 2024 was 9.8 percent (130,802 to 143,569).

⁹ Ministry of Social Affairs and Employment, Third Monitoring Report on the Wajong Simplification Act, 16 April 2025 (Parliamentary Document 35213, no. AC). Labour participation in regular employment of Wajongers with labour capacity stood at 51.0 percent in 2024 (55.8 percent including self-employed), against 50.4 percent in 2019. Among Wajongers without work in 2024, 76 percent had not worked for three or more years, against 70 percent in 2020.

¹⁰ Participation Act social-assistance norm 2025-2026, compared to Wajong benefit at labour capacity (seventy percent of statutory minimum wage since 2018). The approximately thirty percent difference in net benefit level depends on living situation, allowances and exemptions, but is used as a guide value by both UWV and the National Ombudsman.

¹¹ Wajong Simplification Act, Bulletin of Acts and Decrees 2020, 173, in force per 1 January 2021. The act extended the reactivation period from five years to retirement age and removed the automatic status-loss rule on earning a year of self-supporting minimum wage.

¹² None of the three monitoring reports (2022, 2023, 2025), the implementation test (July 2023, published January 2024), the experience study among the target group, or the UWV annual reports 2021-2024 publishes the number of submitted or granted Wajong reactivation requests since the act came into force. A Freedom of Information request to UWV could supply this.

¹³ Ministry of Social Affairs and Employment, Third Monitoring Report, cited; followed by the observation that the Banenafspraak creates “little to no extra opportunities” for Wajongers.

¹⁴ Netherlands Labour Inspectorate, On Paper Labour Capacity, in Practice No Real Chance of Work, July 2024. The inspectorate concludes that approximately thirty-one thousand persons in the Banenafspraak target group did not work at all in 2019-2021, and that the target of one hundred and twenty-five thousand jobs by 2026 is unachievable under unchanged policy.

¹⁵ Regioplan, Evaluation of the Wajong Benefit Reduction 2018: Effects on Labour Participation and Income Position (2025), commissioned by the Ministry of Social Affairs and Employment.

¹⁶ Improven, Final Report on Youth-Care Spending 2023 and 2024 (commissioned by the Ministry of Health), 1 November 2024. Spending 6.5 billion (2022), 7.2 billion (2023, plus 11 percent), forecast 8.1 billion (2024, plus 12 percent); deficits against the multi-year financial framework: 628 million (2023) and 828 million (2024), cumulatively almost 1.5 billion. Client volume 380,000 (2015) to nearly 473,000 (2024). Average duration of non-residential youth care from 290 days (2015) to 406 days (2023).

¹⁷ Expert Committee Hervormingsagenda Jeugd (Van Ark Committee), Growing Pains: Interim Advice, 30 January 2025. Conclusion that the savings target of €1 billion from 2026 onward is unachievable; reference figure 7.7 billion for 2024 for future indexation.

¹⁸ Ministry of the Interior and Kingdom Relations, press release 18 April 2025 with the Spring Memorandum; €3 billion extra for municipalities over 2025-2027, additional compensation €728 million for youth-care deficits 2023-2024.

¹⁹ The “ravine year” refers to the projected structural deficit situation of municipalities from 2026 onward as a result of the wind-down of compensation arrangements from the Municipalities Fund; Council for Public Administration, Municipal Finances 2026 and Beyond (2025).

²⁰ Statistics Netherlands, Health Accounts 2024, press release October 2025; total health spending €155 billion, 13.8 percent of gross domestic product.

²¹ Jacob Huibers, Restoration State Netherlands, Statecraft position paper (2025); the architecture of Dutch public administration since New Public Management (1980) and the General Senior Civil Service (1995) as explanation for the systematic absence of long-term ownership.

²² Strukturreformen, in force 1 January 2007, reduced the number of Danish kommuner from 271 to 98 and the number of regional units from thirteen amter to five regioner; source: Ministry of the Interior and Health, Kommunalreformen i 2007. Sweden has 290 kommuner (Sveriges Kommuner och Regioner). The Netherlands has 342 municipalities per 1 January 2026 (CBS Statline). Average inhabitant numbers: Denmark approximately 60,000, Sweden approximately 36,000, Netherlands approximately 53,000.

²³ Bekendtgørelse om finansiering af visse ydelser og tilbud efter lov om social service samt betaling for unges ophold i Kriminalforsorgens institutioner (Order no. 864/2025), retsinformation.dk; since 1 January 2021 tiered 25/50/75 percent state reimbursement above 0.83/1.63/2.05 million DKK per client per year (2020 price level, annually indexed via satsregulering); multi-child-family criterion lowered from four to two children, age limit of 67 removed, monthly reporting since 2022. Additionally on the basis of section 181 of the Serviceloven 100 percent state reimbursement for specific categories (unaccompanied minors, certain placements within 24 months after residence permit).

²⁴ Act no. 721 of 13 June 2023, Barnets Lov, in force 1 January 2024 (consolidated LBK no. 282 of 17 March 2025). Political basis: agreement text Børnene Først (Children First) of 11 May 2021. Main lines: child obtains party status from age ten (was twelve), stricter regime børnefaglig undersøgelse, one integrated regulatory system for disability and child-welfare cases, mandatory friend-family for children placed in institutions. The refusion system of section 176 of the Serviceloven was technically transferred to the Barnets Lov; amounts unchanged.

²⁵ Elderly care in Denmark: hjemmehjælp (Serviceloven §§ 83-87, from 1 July 2025 Ældreloven no. 1701 of 30 December 2024) and plejebolig (Serviceloven § 192) are both fully kommunal. The kommune is the sole budget holder, gatekeeper and executor. Per Act no. 719 of 20 June 2025 the wider kommunal co-financing of specialist hospital care is being abolished.

²⁶ Lag (1993:387) om stöd och service till vissa funktionshindrade (LSS); Socialförsäkringsbalken chapter 51 (assistansersättning); Inspectorate for Social Insurance, reports on LSS assessments 2014-2015. State assistansersättning fell from over 16,000 persons in 2008 to under 13,500 in 2022, after stricter interpretation of the concept “grundläggande behov” by the Försäkringskassan, confirmed by the Supreme Administrative Court (HFD 2009 ref. 57 and HFD 2012 ref. 41).

²⁷ Norwegian Samhandlingsreformen (2012-2015): kommunal co-financing of specialist care abolished per 2015 due to undesired behavioural effect (shift to private rehabilitation clinics); Hagen, Effects of the Norwegian Coordination Reform on rehabilitation services, BMC Health Services Research (2016). Finnish sote-uudistus (2023): 21 hyvinvointialueet (wellbeing services counties) took over health and social care plus fire services from approximately 309 kommuner; Ministry of Social Affairs and Health Finland (stm.fi).