ABSTRACT
The logic of care and the logic of choice each come in several versions. This chapter starts out from choice in its market form and uses this as a point of contrast to the specificities of care.1 When the language of the market is mobilised, patients are referred to as ‘customers’. They buy their care in exchange for money. This implies that patients do not need to feel gratitude for the care they receive, which they might feel obliged to if care were a gift. Instead, the language of the market makes it possible to say that patients are entitled to value for money, and that health care should follow patient demand instead of being supply-driven. The logic of choice suggests that, if supply were indeed to follow demand, care would – at long last – be guided by patients. But will patients really be better off when they are transformed into customers? This is the question I will explore in this chapter. I will not address all aspects of marketisation. Even if I talk about ‘the market’, the complex issue of how to best finance health care will be bracketed. As will be the role of insurance companies. I will not consider the effects of various combinations of state regulation and market ordering for how professionals end up working. I will also skip questions about the lessons managers of health-care institutions might learn from banks, shops and hotels (how to improve organisational routines, cluster appointments on a single day, make visiting hours more flexible, etc.). Instead I will focus on what happens inside the consulting room. Are patients in a consulting room indeed customers who are eager to buy something? Or is something else going on behind these closed doors?
