ABSTRACT
In recent years the reform of public health-care policies has been high on the political agenda. Several governments have installed special committees to produce proposals on such issues as new systems of insurance, the criteria for access to medical technology or the provision of care for the elderly. There is also a search for new institutional settings and decision-making procedures that can change the deeply entrenched power relations in the medical sector. The context of these new policy designs is that of the restructuring of modern welfare states. There are of course many relevant differences between countries in this respect. While in the United States the Clinton administration has tried to introduce a scheme of mandatory health-care insurance, successive Dutch governments have tried to save public funds by distinguishing a ‘basic package’ of necessary health services from less necessary services to be paid for privately.1 A common denominator in both these policies, however, is the fact that new relations and balances between public and private health-care provisions are being discussed. There seems to be a widely shared view that while, on the one hand, nation-states cannot make available all the health-care services technologically possible, on the other hand, market forces cannot provide these services in accordance with the basic principles of social justice and political solidarity.
