Care, Cost and Questions of Control. Dutch Health Care Reform 1987-2006

Abstract

This thesis deals with the question of how the 1987 market-oriented reform plans concerning health care (the Dekker-plan) were gradually implemented in the period up until 2006. In investigation this question, the research is divided up into two parts. The first part presents a narrative of the trials and tribulations of system reform between 1987 and 2006 on the political-institutional level. The second part consists of one case study and one background study into the various groups, actors and ideologies determining the face of Dutch health care in the decades in which this system reform was implemented. As such, this part is marked by a more cultural-institutional approach. Ultimately, the conclusion is that the system reform was dependent in part on short-term factors such as specific politicians - Hans Simons, Els Borst and Hans Hoogervorst - but also on a more foundational history of social solidarity vs. market behavior in health care on the level of doctors, patients and health insurers. The 2006 Health Care Insurance Act reflects this history, as it contains both market elements and (primarily) strong elements of social solidarity and ideals of distributive justice.