There is probably no other sector of the welfare state where the gap between citizen's expectations and government's opportunities is deepening so intensely and has such a complex and politicized reform agenda as the health care sector. Health care is a critical case par excellence to study the relation between efficiency and legitimization of welfare state reform. The leading question of this special issue of Beleid & Maatschappij is: how does the Dutch health care system and the connected public policymaking accommodate the different and often conflicting goals (input), organizing concepts (throughput) and outcomes (output)? With these questions in mind the dominant governance principles of Dutch health care, especially the system of regulated competition, are scrutinized. One of the findings is, that 'second best' solutions are the highest achievable in this field, a notion that reform policies should take into account. |
Beleid en Maatschappij
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Artikel |
Gezondheidszorg: een stelsel van stelsels |
Auteurs | Tom van der Grinten, Jan-Kees Helderman en Kim Putters |
SamenvattingAuteursinformatie |
Artikel |
Rivaliserende waarden, eisen en wensen in de gezondheidszorg |
Auteurs | Jan Kasdorp |
SamenvattingAuteursinformatie |
This article explores the shifting balance of health care values during the past thirty years. It becomes clear that in health care decision making the values and goals of the government policy gained weight in relation to those of the health care sector itself. The same is true for the health care insurances. The market ideology, the private aspects of health care insurances and in general the economical approach of health care appears to have gained influence compared to the medical approach, the public aspects of the health insurances and the professional interests of the health care sector. This article ends with a discussion about the possible implications of these shifts for the coming change of the health care insurance system. |
Artikel |
Rivaliserende sturingsconcepten in de gezondheidszorg |
Auteurs | Erik Schut |
SamenvattingAuteursinformatie |
This paper addresses the question whether potentially conflicting health policy goals can explain the presence of multiple competing health policy programs. For more than fifteen years, successive government coalitions have proposed to replace the dominating policy program of supply and price regulation by the policy program of regulated competition. Due to its institutional and technical complexity, however, so far most efforts have been focused on the realization of the appropriate preconditions for regulated competition and the actual implementation is still in its infancy. The remarkable perseverance of the market-oriented policy program can be explained by the fact that it offers, at least in theory, a single comprehensive solution for satisfying both efficiency and equity goals. Even if the program succeeds in fostering efficiency while maintaining equity, several reasons are pointed out why the market-oriented program is unlikely to fully replace supply and price regulation. First, the market-oriented program does not seem suitable for all health sectors or even for all geographical markets within a specific sector. Second, the market-oriented program is unlikely to meet political objectives about the desired level of public health spending. |
Artikel |
Concurrerende uitkomsten. Reflecties over de relatie tussen stelselwijziging van de gezondheidszorg en volksgezondheid |
Auteurs | Niek Klazinga en Johan Mackenbach |
SamenvattingAuteursinformatie |
This article provides an overview of the various initiatives in the past decades to measure the outcomes of health care systems from a public health perspective. It is described how on the one hand the performance measurement techniques and its associated indicators have become more sophisticated over the years but on the other hand how the indicators meet difficulties in being incorporated in policy and management by policymakers and politicians. The present health care reform in The Netherlands will enforce the debate on competing health care outcomes (effectiveness, efficiency, equity). Steps are described how to take the steering on health outcomes as a more central notion in health system redesign. |
Artikel |
Stelsel-matig hervormen |
Auteurs | Kim Putters, Jan-Kees Helderman en Tom van der Grinten |
Samenvatting |
There is probably no other sector of the welfare state where the gap between citizen's expectations and government's opportunities is deepening so intensely and has such a complex and politicized reform agenda as the health care sector. Health care is a critical case par excellence to study the relation between efficiency and legitimization of welfare state reform. The leading question of this special issue of Beleid & Maatschappij is: how does the Dutch health care system and the connected public policymaking accommodate the different and often conflicting goals (input), organizing concepts (throughput) and outcomes (output)? With these questions in mind the dominant governance principles of Dutch health care, especially the system of regulated competition, are scrutinized. One of the findings is, that 'second best' solutions are the highest achievable in this field, a notion that reform policies should take into account. |