ABSTRACT
The current Dutch health care system can be likened to a patchwork quilt. It consists of a wide variety of structures, both public and private, funding arrangements, and delivery mechanisms, all of which are held together by a number of underlying principles. These include an emphasis on obligations and responsibilities and on solidarity, accommodation and co-operation between the many different interests which have a stake in the system. In addition, although rarely expressed in these terms, implicit in the system are notions of universality and comprehensiveness and health as a social right. However, in seeking to realise these values, the state has traditionally worked with and through legally independent corporate bodies rather than establish organisational structures of its own. In the words of Kirkman-Liff and Maarse: the Dutch health care system is ‘built on private sector institutions, but regulated to achieve public goals’ (1992:24). Such an approach facilitates the current moves towards a more market-orientated approach in which the role of the state is likely to be diminished.
