Quality of Life in the Polder: About Dutch and EU Policies and Practices in Quality of Life for People with Intellectual Disabilities

In the past few decades both the structure and the culture of the Dutch health-care system have changed. A new insurance system was introduced as well as new legislation. Both were mainly cost-driven, but were also influenced by changing visions. These changes also had implications for the intellectual disabilities field. Quality assurance was introduced, first to monitor and improve health-care processes; later on quality assurance became outcome-oriented. The concept of Quality of Life (QoL) proved to be a useful concept in a sensitizing, organizing and reflecting way. In policy development in the intellectual disabilities field, the concept of QoL meant a paradigm change (sensitizing), implying changes in views and roles of several stakeholders at micro, meso and macro level in the field (organizing). The concept of QoL is used in a reference framework at a national level, as well as in a memorandum at an EU level (reflecting). In practice, the concept of QoL is applied by several organizations in the disabilities field as a sensitizing concept (as seen by the renewing of mission statements and general objectives), with best-practice resulting in organizations refocusing services and programmes. The outcome orientation in the disabilities field has led to the use of the concept of QoL as a reflecting model. The task for the next decade is to internalize, align and broaden the described practices so as to strive for an enhanced quality of life for people with intellectual disabilities.