This chapter describes the last major transition in the Dutch health system took place during 1820-1970. It argues that the foundations and paradigms of the health system have not changed fundamentally over the past decades. In the emergence of the modern Dutch state, 1848 was a landmark year: the monarchy was "constitutionalized" and power shifted to Parliament and government. By the 1920s, modern hospitals and operating theaters bore no resemblance to the nineteenth-century "houses of death" anymore; at the time, people were even willing to pay for separate insurance to be able to afford hospital care. The difference between relevant developments in the years between 1865 and 1900 and those during the period between 1910 and 1990 is that empowerment patterns occurred between the constellations, instead of between constellations and the environment of the system. Healthcare developments that force change upon a societal sector or that fuel the growth of some particular niche may be seen as a reconstellation pattern.