Samenvatting

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.