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.

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.