ABSTRACT
Health care reform is high on the political agenda in many countries. Most of these reforms can be considered as the third stage in the development of arrangements for the financing and organization of health care. Since the economic recession in the late 1970s/early 1980s the Governments of many European countries focused on cost containment strategies in health care. The many conflicts between government and health care providers during the 1980’s resulted in several strikes of physicians and nurses and in other actions of protest. In March 1988 the Dutch government presented a proposal for a market-oriented reform of the health care sector. The Government Committee on Choices in Health Care advised government that the law should stipulate that insurers could refuse to reimburse costs for inappropriate care, that is, cost-ineffective care. If health care costs go up, then the subsidies and the income-related premiums for the mandatory basic insurance will also go up.
