Genoeg is genoeg

Since some years there has been a significant trend in the democratization of health care in the Netherlands. Where in the old days patients used to be able to just rest and receive care, nowadays they have to get active. Not only do they have to keep working as much as possible, they are expected to actively participate in their own treatment, like finding out where you can get the best doctor or how to give yourself injections. Also they have to participate in client councils of the hospital. In this book, Margo Trappenburg discusses the positive but foremost the negative aspects of this hyper- democratization of health care

Street-level bureaucrats in a catch-all bureaucracy

Since 2015 Dutch street-level bureaucrats have ample discretionary space to determine how to help clients. Simultaneously, resources were reduced. According to Zacka SLBs should avoid three pathological positions: indifference, caregiving, and enforcing. At the individual level SLBs supposedly accomplish that by a gymnastics of the self. We observed SLBs. They avoided the pathological positions by (1) reframing the reigning policy for clients (enforcing caringly) and (2) managing clients’ self-image, bolstering their confidence, or tempering their expectations (caring forcefully). SLBs practice a gymnastics of the client alongside a gymnastics of the self. SLBs thus make the reigning policy palatable for clients

‘I can’t just go up to a person to ask what’s going on.’: How Dutch urbanites’ accounts of non-engagement enhance our understanding of urban care

In the context of increasing appeals to informal care in Western welfare state policies, questions concerning urban sociality acquire new significance. This paper aims to contribute to the emergent thinking on ‘urban care’ by situating it in policy debates concerning care responsibilities between citizens. We used small-scale focus groups among urban residents in The Hague (the Netherlands) to inquire into the accounts urbanites give of engaging or not engaging with perceived care needs of a stranger. Informed by Goffman’s ‘civil inattention’, we found that accounts of non-engagement highlight urbanites’ orientation towards maintaining friendly social interactions in the face of strange or worrisome situations. Urbanites feel that they should respect people’s choices even if these might hurt them. They fear that interference might be humiliating and they attribute to themselves the task of sticking to normality, while family members, friends or professionals might take on the task to intervene. This careful non-engagement, contrasted with long-standing accounts of urban indifference, enhances our understanding of urban care

The Doctor and the Market: About the Influence of Market Reforms on the Professional Medical Ethics of Surgeons and General Practitioners in The Netherlands

To explore whether market reforms in a health care system affect medical professional ethics of hospital-based specialists on the one hand and physicians in independent practices on the other. Qualitative interviews with 27 surgeons and 28 general practitioners in The Netherlands, held 2–3 years after a major overhaul of the Dutch health care system involving several market reforms. Surgeons now regularly advertise their work (while this was forbidden in the past) and pay more attention to patients with relatively minor afflictions, thus deviating from codes of ethics that oblige physicians to treat each other as brothers and to treat patients according to medical need. Dutch GPs have abandoned their traditional reticence and their fear of medicalization. They now seem to treat more in accordance with patients’ preferences and less in accordance with medical need. Market reforms do affect medical professional principles, and it is doubtful whether these changes were intended when Dutch policy makers decided to introduce market elements in the health care system. Policy makers in other countries considering similar reforms should pay attention to these results

Government Influence on Patient Organizations

Patient organizations increasingly play an important role in health care decision-making in Western countries. The Netherlands is one of the countries where this trend has gone furthest. In the literature some problems are identified, such as instrumental use of patient organizations by care providers, health insurers and the pharmaceutical industry. To strengthen the position of patient organizations government funding is often recommended as a solution. In this paper we analyze the ties between Dutch government and Dutch patient organizations to learn more about the effects of such a relationship between government and this part of civil society. Our study is based on official government documents and existing empirical research on patient organizations. We found that government influence on patient organizations has become quite substantial with government influencing the organizational structure of patient organizations, the activities these organizations perform and even their ideology. Financing patient organizations offers the government an important means to hold them accountable. Although the ties between patient organizations and the government enable the former to play a role that can be valued as positive by both parties, we argue that they raise problems as well which warrant a discussion on how much government influence on civil society is acceptable

Genoeg is genoeg

Since some years there has been a significant trend in the democratization of health care in the Netherlands. Where in the old days patients used to be able to just rest and receive care, nowadays they have to get active. Not only do they have to keep working as much as possible, they are expected to actively participate in their own treatment, like finding out where you can get the best doctor or how to give yourself injections. Also they have to participate in client councils of the hospital. In this book, Margo Trappenburg discusses the positive but foremost the negative aspects of this hyper- democratization of health care.Nog niet zo lang geleden betekende ziek zijn dat je was vrijgesteld van maatschappelijke verplichtingen. Zieken mochten verzuimen van hun werk en zieken hoefden niet mee te doen aan sociale evenementen die zij niet aankonden. Ziek zijn was misschien niet leuk, maar je rustte er wel lekker van uit. Tegenwoordig ligt dat heel anders. Van zieken wordt verwacht dat zij zoveel mogelijk blijven werken en hun normale taken blijven doen. Teveel rust heet therapeutisch onverantwoord. Naast de normale verplichtingen van gezonde burgers krijgen zieken er zelfs een groot aantal taken bij. Zij moeten actief participeren in hun eigen behandeling, ze moeten zichzelf leren prikken, stoma-zakjes verwisselen, oefeningen doen, uitzoeken waar de beste arts zit voor hun specifieke kwaal, en uitzoeken bij welke verzekeraar zij zich het best kunnen inschrijven als klant. Daarnaast moeten ze idealiter meepraten in de cliëntenraad van het ziekenhuis of de instelling waar zij worden behandeld, meedenken met de medici die richtlijnen opstellen over hun ziekte, meepraten met onderzoekers die van hen willen horen waarnaar zij onderzoek zouden willen doen, meedenken met de overheid over zorgvoorzieningen en het basisverzekeringspakket en meedoen aan talloze cursussen, symposia, en themamiddagen over vraagsturing, empowerment en 'het patiëntenperspectief'. Margo Trappenburg bespreekt in Genoeg is genoeg de positieve, maar vooral ook de negatieve gevolgen van deze hyperdemocratisering in de zorg

‘The only thing I do is coordination’: On the voluntarisation of social work in the Netherlands

Social work once started as volunteering and then turned into a paid profession. At present many countries try to outsource large parts of social work to volunteers. This article studies this process of voluntarisation in one large social work organisation in the Netherlands. It is based on interviews with social workers, managers and volunteers at this organisation. The study shows that voluntarisation need not go to the detriment of service quality, partly because volunteers do a good job and partly because paid social workers teach them how to do that. From a quality of work perspective voluntarisation causes concerns. Firstly because it forces paid social workers to put up with competitors who are willing to work for free and secondly, because voluntarisation often means that the core part of the job (contact between worker and service user) is outsourced to volunteers, while paid social workers are tasked with management responsibilities: coaching, budgeting, coordinating and making decisions. Because of this, we recommend a more critical stance toward voluntarisation than is currently in vogue

Genoeg is genoeg : Over gezondheidszorg en democratie

Nog niet zo lang geleden betekende ziek zijn dat je was vrijgesteld van maatschappelijke verplichtingen. Zieken mochten verzuimen van hun werk en zieken hoefden niet mee te doen aan sociale evenementen die zij niet aankonden. Ziek zijn was misschien niet leuk, maar je rustte er wel lekker van uit. Tegenwoordig ligt dat heel anders. Van zieken wordt verwacht dat zij zoveel mogelijk blijven werken en hun normale taken blijven doen. Teveel rust heet therapeutisch onverantwoord. Naast de normale verplichtingen van gezonde burgers krijgen zieken er zelfs een groot aantal taken bij. Zij moeten actief participeren in hun eigen behandeling, ze moeten zichzelf leren prikken, stoma-zakjes verwisselen, oefeningen doen, uitzoeken waar de beste arts zit voor hun specifieke kwaal, en uitzoeken bij welke verzekeraar zij zich het best kunnen inschrijven als klant. Daarnaast moeten ze idealiter meepraten in de cliëntenraad van het ziekenhuis of de instelling waar zij worden behandeld, meedenken met de medici die richtlijnen opstellen over hun ziekte, meepraten met onderzoekers die van hen willen horen waarnaar zij onderzoek zouden willen doen, meedenken met de overheid over zorgvoorzieningen en het basisverzekeringspakket en meedoen aan talloze cursussen, symposia, en themamiddagen over vraagsturing, empowerment en 'het patiëntenperspectief'. Margo Trappenburg bespreekt in Genoeg is genoeg de positieve, maar vooral ook de negatieve gevolgen van deze hyperdemocratisering in de zorg