Transitions in the social domain: a task for public health as well

Dutch municipalities will be responsible for non-hospital care soon. This care is now publicly insured by the AWBZ (Exceptional Medical Expenses Act). This type of care concerns in particular vulnerable elderly and disabled people. The transition from public insurance to a task for municipalities changes the extramural longterm care from a right to local customization. Karel- Peter Kompanje puts this transition from insured care to social services in a historical perspective as a change from a welfare state to self-reliance with a public safety net. The question is what this means for the public health sector, that, to a large extent, is organized in Municipal Health Services with disciplines as social medicine, epidemiology and health promotion. According to Theo Trompetter the discipline of social medicine already builded up expertise to assist municipalities with medical advice for situations municipal civil servants cannot judge completely. Van Bon states that epidemiologists of the Municipal Health Services can provide local authorities with facts and figures on the new target groups they have to take care for. Koornstra shows a variety of public health expertise the Municipal Health Services can offer to support the local health authorities in their efforts to deal with their new tasks in the social domain. Aveskamp demonstrates as municipal civil servant how municipalities prepare themselves for their new tasks. He makes clear that the Municipal Health Service is just one of the partners in that process. In that perspective, Municipal Health Services must be more active to show their expertise and competencies to alderman. In the last contribution, Sachse asks attention for the coming law on youth care for witch municipalities will become fully responsible also. The relevance for Municipal Health Services is clear if we take into account that they are involved strongly in youth health care as it is a discipline of social medicine also.