The Changing Role of the State in the Dutch Healthcare System

Götze, Ralf

doi:10.2139/ssrn.1715124

Cited by 6 publications

(4 citation statements)

References 55 publications

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“…During the last two decades, healthcare systems in western societies have undergone reforms based on neoliberal principles (Götze, 2010). One consequence of this is that it invites “people to see certain problems as the responsibility of the individual rather than, for example, the state” (Harper and Speed, 2014, p. 5).…”

Section: Introductionmentioning

confidence: 99%

Professionals’ involvement of relatives – only good intentions?

Glasdam

Oute

2019

JOE

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Purpose The purpose of this paper is to explore how, and under what conditions, professionals involve relatives in clinical practice. Design/methodology/approach Two cases were constructed from two studies in Denmark, theoretically inspired by Bourdieu’s concepts of doxa and position and analyzed with focus on the involvement of relatives from the perspective of professionals. Findings Support to relatives in practice is rarely included in the way that treatment and care are organized in healthcare. Professionals’ views of the involvement of relatives were characterized by the values of neoliberal ideology and medical-professional rationality, in which relatives are not regarded as a subject of care and support in clinical practice. The involvement of relatives aimed to ensure patients’ participation in randomized clinical trial and to help professionals to care for patients when the professionals were not absolutely needed. Professionals were relatively higher positioned in the clinic than relatives were, which allowed professionals to in – and exclude relatives. Neoliberal ideology and medical-professional rationality go hand in hand when it comes to patient treatment, care and the involvement of relatives; it is all about efficiency, treatment optimization and increased social control of the diagnosed patient. These neoliberal, organizational values consolidate doxa of the medical field and the positions that govern the meeting with patients’ relatives – if it takes place at all. Originality/value The results put into perspective how the combination of neoliberalism and medical logic work as an organizing principle in contemporary healthcare systems, and challenge a normative, humanistic view on involving patients’ relatives in the medical clinic.

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Section: Introductionmentioning

confidence: 99%

Professionals’ involvement of relatives – only good intentions?

Glasdam

Oute

2019

JOE

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“…Data for insured persons comes from Götze (2010). Finally, we take a state subsidy in account reducing the financial burden of the nominal ZVW premium for low-income households since 2006 (Agasi 2008).…”

Section: Sfb 597 "Staatlichkeit Im Wandel" -"Transformations Of the Smentioning

confidence: 99%

Keeping an Eye on Iris: Risk and Income Solidarity in OECD Healthcare Systems

2015

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Sfb 597 "Staatlichkeit im Wandel" -"Transformations of the State" (WP 191) ABSTRACTIn most wealthy democracies as represented by long-term OECD-members, healthcare systems have been established which guarantee access to a broad package of health services. However, healthcare financing involves varying distributive effects and builds on different concepts of solidarity. Healthcare researchers have examined these equity issues in healthcare financing measuring the progressivity of healthcare financing using micro-level data. Most notably, the ECuity-project published progressivity indices in some European countries and the US for the late 1980s and early 1990s. Not least due to the rather complex procedure involved with the evaluation of income and expenditure surveys, such indices have been rarely calculated since.From these studies on redistributive effects, we know that the main modes of financing quite consistently correspond to different levels of progressivity. Moreover, financing modes reflect different concepts of solidarity. Therefore, we suggest an alternative indicator to explore equity issues in healthcare financing using aggregate spending and revenue data. The Index of Risk and Income Solidarity (IRIS) is based on the respective share of distinct modes of financing. We distinguish modes of financing which involve ex-ante redistribution of health risks from those which entail only ex-post redistribution or none at all. Further, we differentiate financing modes which are related to personal or household income from those which involve no income redistribution.We assume an increase of risk solidarity as well as a decline of income solidarity in the OECD-world. First of all, new and costly medical technologies drive the demand for ex-ante redistribution of health risks. At the same time, hopes to increase efficiency of healthcare provision through forms of co-payments have been disappointed. The decline of income solidarity is expected as a result of global competition. In order to reduce labour costs, OECD countries substitute social security contributions by flat-rate premiums or general taxes. In the light of global competition, governments also tend to strengthen indirect taxes since it is far more difficult to shift consumption abroad. Finally, we assume that it is easier to legitimize rising tobacco or alcohol taxes if they are ear-marked for healthcare financing.We examine these assumptions presenting time series of risk and income solidarity based on OECD health data, OECD revenue statistics and national aggregate data on healthcare financing. We cover eleven OECD countries: Australia,

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“…While France and Germany kept or even enhanced the role of contributions, Iceland and the Netherlands hybridized their funding schemes. In 1986, the Dutch government abolished the voluntary sickness funds and its former members had to choose (state controlled) private plans (Götze 2010). Iceland even switched over to the predominantly tax financed systems.…”

Section: Completely Mixedmentioning

confidence: 99%

Healthcare Financing in OECD Countries Beyond the Public-Private Split

Götze

Schmid

2012

SSRN Journal

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Background: Studies of long-term trends in the healthcare financing mix generally focus on a dichotomous concept discerning public from private funding sources. More detailed analyses of the funding mix tend to be restricted to a small number of cases or do rarely examine time trends. Aim: This paper enhances the existing body of literature by developing and applying a trichotomous concept for healthcare funding, distinguishing taxes, contributions, and private sources. This includes a new aggregated indicator for the mix of three financing sources and its graphical representation. Methods: The study mainly builds upon OECD Health Data 2011. We measure changes in the funding mix since 1972 as its distance from a funding mix that equally draws upon taxes, contributions and private sources. Results: Up to 1980, the OECD healthcare systems move toward ideal-typical financing schemes. Between 1980 and 2000, the funding mix hybridizes mainly driven by privatization processes in NHS and social insurance countries and ongoing switch-overprocesses between these two healthcare system types. Since 2000, OECD countries again tend toward ideal-typical funding schemes. Discussion: We use the framework for institutional change developed by Streeck and Thelen. The quantitative approach highlights changes in terms of displacement, layering, and drift but fails to fully reveal conversion processes. Therefore, further qualitative research is needed to capture not only shifts between the funding sources but also more gradual changes within them. Conclusion: The back-and-forth development of the trichotomous funding mix challenges assumptions of a universal trend toward hybrid financing structures.

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The Changing Role of the State in the Dutch Healthcare System

Cited by 6 publications

References 55 publications

Professionals’ involvement of relatives – only good intentions?

Professionals’ involvement of relatives – only good intentions?

Keeping an Eye on Iris: Risk and Income Solidarity in OECD Healthcare Systems

Healthcare Financing in OECD Countries Beyond the Public-Private Split

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