http://repub.eur.nl/res/aut/22371/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/38721/ 2013-01-01T00:00:00Z In many Western countries, options for citizens to influence public services are increased to improve the quality of services and democratize decision making. Possibilities to influence are often cast into Albert Hirschman’s taxonomy of exit (choice), voice, and loyalty. In this article we identify delegation as an important addition to this framework. Delegation gives individuals the chance to practice exit/ choice or voice without all the hard work that is usually involved in these options. Empirical research shows that not many people use their individual options of exit and voice, which could lead to inequality between users and nonusers. We identify delegation as a possible solution to this problem, using Dutch health care as a case study to explore this option. Notwithstanding various advantages, we show that voice and choice by delegation also entail problems of inequality and representativeness. http://repub.eur.nl/res/pub/38586/ 2012-07-01T00:00:00Z Dit rapport gaat over Arduin, een organisatie die een pilot is gestart om vanuit zelfsturende teams een doorontwikkeling te maken naar een organisatievorm waarbij ouders en het sociale netwerk nauw betrokken zijn bij hun kind/kennis. De pilot maakte onderdeel uit van de 10 experimenten van Wijk- en Buurtgericht Werken 2011. Doel van deze experimenten is om op wijkniveau de langdurige zorg ook in de toekomst duurzaam, leverbaar en betaalbaar te houden. Door deelname werd een proeftuin gecreëerd waarin vier pilotwoningen de mogelijkheid kregen om in de praktijk te experimenteren en de grenzen op te zoeken en te overschrijden om te ontdekken hoe Arduin zijn visie kan verwezenlijken. http://repub.eur.nl/res/pub/34701/ 2012-06-01T00:00:00Z In this paper we argue that performance measurement can be done better by general, less accurate measurements than by complex - and possible more accurate - ones. The conclusions of this study are drawn from a case study of the Dutch Foundation for Effective Use of Medication. While most studies about performance measurements focus on the management of public service organizations, this case study - informed by the literature from Science and Technology Studies - focuses on the active role of the measurements themselves. In the paper we show that indicators do not have to be as complex as the practices they represent - as long as they are part of a chain of intermediary data that allow travelling from the general or simple indicators to detailed data in day-to-day practices and vice versa. Furthermore, general indicators enable stakeholders to obtain distance from each other. Rather than the involvement of stakeholders, it is this reflexive distancing that explains the degree of compliance to performance measurement and thereby the prospect for effective co-governance. http://repub.eur.nl/res/pub/34699/ 2012-01-01T00:00:00Z The presence of undocumented migrants is increasing in many Western countries despite wide-ranging attempts by governments to increase border security. Measures taken to control the influx of immigrants include policies that restrict access to publicly funded health care for undocumented migrants. These restrictions to health care access are controversial, and evidence suggests they do not always have the intended effect. This study provides a comparative analysis of institutional, actor-related, and contextual factors that have influenced health care policy development on undocumented migrants in England and the Netherlands. For undocumented migrants, England restricts its access to care at the point of service, while the Netherlands restricts through the payment system for services. The study includes an analysis of policy papers and semistructured, in-depth interviews with various actors in both countries. Findings confirm the influence of such contextual factors as immigration considerations and cost concerns on health care policy making in this area. However, these factors cannot explain the differences between the two countries. Previously enacted policies, especially the organization of the health care system, affected the kind of restrictions for undocumented migrants. Concerns about the side effects of generous treatment of undocumented migrants on other groups played a substantial role in formulating restrictive policies in both countries. Evidently, policy development and implementation is critically affected by institutional rules, which govern the degree of influence that doctors and professional medical associations have on the policy process. http://repub.eur.nl/res/pub/38661/ 2012-01-01T00:00:00Z Dit rapport gaat over Arduin, een organisatie die een pilot is gestart om vanuit zelfsturende teams een doorontwikkeling te maken naar een organisatievorm waarbij ouders en het sociale netwerk nauw betrokken zijn bij hun kind/kennis. De pilot maakte onderdeel uit van de 10 experimenten van Wijk- en Buurtgericht Werken 2011. Doel van deze experimenten is om op wijkniveau de langdurige zorg ook in de toekomst duurzaam, leverbaar en betaalbaar te houden. Door deelname werd een proeftuin gecreëerd waarin vier pilotwoningen de mogelijkheid kregen om in de praktijk te experimenteren en de grenzen op te zoeken en te overschrijden om te ontdekken hoe Arduin zijn visie kan verwezenlijken. http://repub.eur.nl/res/pub/21611/ 2010-11-07T00:00:00Z In this paper we argue that performance measurement can better be done by general, less accurate measurements than by complex – and possible more accurate - ones. The conclusions of this study are drawn from a case study of the Dutch Foundation for effective use of medication. While most studies about performance measurements focus on the management of public service organizations, this case study - informed by the literature from Science and Technology Studies – focuses on the active role of the measurements themselves. Indicators, we show, do not have to be as complex as the practices they represent, as long as they are part of a chain of intermediary data that allow traveling from the general or simple indicators to detailed data in day-to-day practices and vice versa. Furthermore, general indicators enable stakeholders to take distance from each other. Rather than the involvement of stakeholders, it is this reflexive distancing that explains the degree of compliance to performance measurement and thereby the prospect for effective co-governance. http://repub.eur.nl/res/pub/21240/ 2010-07-01T00:00:00Z The introduction of the Dutch Social Support Act (in Dutch: Wmo) in 2007 symbolises a major welfare state reform in the Netherlands. It concerns the decentralisation of tasks and responsibilities with regard to social care and support. This reform is not only a matter of shifting tasks and responsibilities from central government to local government; the Wmo was also intended to cause a paradigm shift that should change the way in which clients, citizens, governments and providers act and think. The core of this paradigm is formed by the compensation principle which describes the replacement of citizens’ rights on care by an obligation for municipalities to compensate citizens. If the Wmo is however purely regarded as a decentralisation of tasks, its implementation may, three years after its introduction, be considered a success. After all, municipalities are making serious efforts to regulate home care and social support. Most crucially, however, is the question whether this actually leads to a realisation of the Wmo’s underlying goals and ambitions. This question is addressed in this report. http://repub.eur.nl/res/pub/19781/ 2010-06-01T00:00:00Z Abstract: Discussions on the role of markets in healthcare easily lead to political and unfruitful polarized positions. Actors arguing in favour of markets as a solution for the quality/cost conundrum entrench themselves against others pointing out the risk of markets for the delivery and governance of healthcare. These binary options of more or less marketization preclude a more empirical analysis of how markets, as multiple arrangements, are constructed and what their consequences are for public values like affordability and quality. To empirically explore the relation between markets and public values in healthcare, in this paper we analyze the construction of a market for hospital care in the Netherlands, based on a system of diagnoserelated groups (DBCs), and the development of a market for long term care based on care-load packages (ZZPs). In these cases we address the intended result of care markets according to various policy actors, the visible and invisible work done by various actors to make markets work and the values enacted in market practices. We show that where policy aims within these markets focus on providing choice and increasing diversity of care institutions, the instruments of DBCs and ZZPs rather produce isomorphism and homogenization. Furthermore, the strong influence of financial instruments in shaping healthcare markets assume that cost and quality can both be strengthened while it in fact has a profound influence on how public values like quality get defined in practice. These translations between values pursued and outcomes produced indicate that conceptualizing the role of the state as defining public values that markets (have to) implement is problematic, as this removes crucial normative work in the shaping of our welfare states to the realm of the technical operationalization of markets. An alternative relation between state, market and society can be conceived once we accept that such values are shaped in practice and that the relationship between policy aims and policy consequences can never be fully captured through a logic of implementation. This then calls for an experimental role of the state: a state that sees market developments as experimental devices in which the aim is a good composition of public values. We propose this experimentation could for example focus on market developments that do not ascribe a privileged status to financial devices and price-mechanism, such as a market for the DBC A-segment, in which prices are not freely negotiable. Such experiments could allow competition to focus on other public values like quality and maintaining accessibility while at the same time function as learning laboratories for reconceiving the role between state, market and society. http://repub.eur.nl/res/pub/19202/ 2010-03-01T00:00:00Z Objective To study whether the Dutch participation model is a good model of participation. Background Patient participation is on the agenda, both on the individual and the collective level. In this study, we focus on the latter by looking at the Dutch model in which patient organizations are involved in many formal decision-making processes. This model can be described as neo-corporatist. Design We did 52 interviews with actors in the healthcare field, 35 of which were interviews with representatives of patient organizations and 17 with actors that involved patient organizations in their decision making. Results Dutch patient organizations have many opportunities to participate in formal healthcare decision making and, as a result, have become institutionalized. Although there were several examples identified in which patient organizations were able to influence decision making, patient organizations remain in a dependent position, which they try to overcome through professionalization. Discussion Although this model of participation gives patient organizations many opportunities to participate, it also causes important tensions. Many organizations cannot cope with all the participation possibilities attributed to them. This participation abundance can therefore cause redistribution effects. Furthermore, their dependent position leads to the danger of being put to instrumental use. Moreover, professionalization causes tensions concerning empowerment possibilities and representativeness. Conclusion Although the Dutch model tries to make patient organizations an equal party in healthcare decision making, this goal is not reached in practice. It is therefore important to study more closely which subjects patients can and should contribute to, and in what way. http://repub.eur.nl/res/pub/21907/ 2009-11-01T00:00:00Z ABSTRACT Background: Policy instruments based on the working of markets have been introduced to empower consumers of healthcare, however it is not easy to become a critical consumer in healthcare. Objectives: The aim of this study is to analyze the possibilities of the state to strengthen the influence of patients with the aid of a new financial regime, such as personal health budgets. Methods: Data were collected through in-depth interviews with executives, managers, professionals and client representatives of six long-term care institutions. Results: Introducing individual budgets implies that the responsibility for budgetary control is shifted from the organizational level to the individual level of the caregiver-client relation. Offering more luxurious care necessitates a stronger demarcation of standard care because organizations cannot simultaneously offer extra care part of regularly care. Hence, new financial instruments influence the culture of care receiving and giving. Distributive justice takes on new meaning with the introduction of financial market mechanisms in healthcare; the distributing principle of ‘need’ is transformed into the principle of ‘economic demand’. Conclusion: Financial instruments acted not only as a countervailing power against that are not client-oriented enough, but were also used by providers to reinforce their own position vis-à-vis demanding clients. Tailor-made finance is not the same as tailor-made care.