Continuity and Change

Abstract

This article aims to understand the evolution of health care governance in the Dutch hospital and home care sector. We pay particular attention to how institutionalized governance structures shape policy reform. Professionallydominated governance structures are likely to continue to exist to some degree, even when new policy measures seek to introduce hierarchical control or market mechanisms in order to restrict professional autonomy. In contrast to the home care profession, the dominance of the medical profession with its high corporate power has been institutionalized into the governance structure, constraining actors' choices in ways that only permit incremental changes in hospital care.

Bridging social distances in home care in super-diverse settings: a study of workers, clients and care organisations in the Netherlands

“…Home-care organisations must operate within the bounds of national policy. Compared to most European countries, home care in the Netherlands is well developed (OECD, 2020); a large percentage of the elderly use public care provisions, though budget cuts and New Public Management have swollen workloads (Oomkens et al, 2015;Van Wieringen, 2019). Around 17 per cent of home-care workers in the Netherlands are first-or second-generation immigrants, which is lower than in many other countries in Europe (ACVZ, 2021).…”