PubMed · 10308231
The source did not provide an abstract. Follow the original record for more information.
Explore connections, maps & timelines
S Shapiro. 1978. Shapiro blasts PSRO'S.. https://pubmed.ncbi.nlm.nih.gov/10308231/
Cite the original work for its findings. Save a collection to share your selection of sources.
KEEP EXPLORING
Explore the source record for details and available documents.
In the second half of the 1980s the government in the Netherlands adopted a regulated competition policy as part of a comprehensive programme designed to restructure the health care system. The programme was a product of its social and political context, promoted by a group of political entrepreneurs and created to improve efficiency. Despite the initial political support and a long political debate the government had to acknowledge by 1992 that the restructuring would not take place. But changes fostered limited competition between sickness funds and more extensive competition in the small market for supplementary policies. This, however, has not led to sickness funds becoming powerful purchasers that forced hospitals and doctors to improve their efficiency. Rather, they compete for subscribers, become part of large insurance conglomerates, and market more supplementary options. Culturally, health care institutions have become more entrepreneurial, taken up more business concepts, and made the language of markets, products and consumer sovereignty more common. The impact of these changes on the health care system is still unknown, but they create pressure for more health care services, leaving the government with problems that equal those of the 1980s.
This paper develops a relational analysis (drawing on the insights of historical institutionalism and economic sociology) of the ongoing process of radical health sector restructuring in New Zealand. The original 'reforms', based on a 'purchaser provider' split, are outlined so as to emphasize their politically consequential ambiguity: was restructuring about revitalizing an essentially public health system or about creating the basis for an eventually private health system with a residual state role? The actual process of restructuring is then traced, emphasizing the responses it has evoked from differently situated actors within the health sector as this is entwined with the political system. The focus is on explaining the largely unintended consequences that have resulted, including the abandonment or significant modification of most of the originally enacted forms of organization together with the emergence of new organizational forms, initiated by providers, and largely unanticipated by the restructurers.