The development of Demand-driven care as a new governance concept

Demand-driven care is oriented towards an empowerment of patients/consumers through a redistribution of responsibilities and control among government, healthcare providers, insurers and patients. Different normative approaches can be distinguished in the discussion about the implementation and development of demand-driven care. The economic approach is aimed at competition and consumerism. The democratic approach of demand-driven care focuses on shared social responsibilities and accountability between the actors involved. In practice both approaches don’t get full meaning. The characteristics of sub-sectors within the healthcare system, institutional inertia and conflicting interests hamper a real shift form supply-oriented towards demand-oriented health care.Session 4: Public Managemen

Markets and Public Values in Healthcare

Abstract: Discussions on the role of markets in healthcare easily lead to political and unfruitful polarized positions. Actors arguing in favour of markets as a solution for the quality/cost conundrum entrench themselves against others pointing out the risk of markets for the delivery and governance of healthcare. These binary options of more or less marketization preclude a more empirical analysis of how markets, as multiple arrangements, are constructed and what their consequences are for public values like affordability and quality. To empirically explore the relation between markets and public values in healthcare, in this paper we analyze the construction of a market for hospital care in the Netherlands, based on a system of diagnoserelated groups (DBCs), and the development of a market for long term care based on care-load packages (ZZPs). In these cases we address the intended result of care markets according to various policy actors, the visible and invisible work done by various actors to make markets work and the values enacted in market practices. We show that where policy aims within these markets focus on providing choice and increasing diversity of care institutions, the instruments of DBCs and ZZPs rather produce isomorphism and homogenization. Furthermore, the strong influence of financial instruments in shaping healthcare markets assume that cost and quality can both be strengthened while it in fact has a profound influence on how public values like quality get defined in practice. These translations between values pursued and outcomes produced indicate that conceptualizing the role of the state as defining public values that markets (have to) implement is problematic, as this removes crucial normative work in the shaping of our welfare states to the realm of the technical operationalization of markets. An alternative relation between state, market and society can be conceived once we accept that such values are shaped in practice and that the relationship between policy aims and policy consequences can never be fully captured through a logic of implementation. This then calls for an experimental role of the state: a state that sees market developments as experimental devices in which the aim is a good composition of public values. We propose this experimentation could for example focus on market developments that do not ascribe a privileged status to financial devices and price-mechanism, such as a market for the DBC A-segment, in which prices are not freely negotiable. Such experiment

De Volksgezondheid Toekomst Verkenning als infrastructuur voor evidence-based gezondheidsbeleid

__Kernpunten:__ - Een uitsluitend rationeel perspectief op de relatie tussen kennis en beleid kan leiden tot een verdere formalisering van deze relatie, met negatieve consequenties voor de waarde van wetenschappel

Knowledge in process? Exploring barriers between epidemiological research and local health policy development

The Redes de Trueque (RT) thrived during the economic crisis of 2001 – 2002 in Argentina and still stand out as one of the largest Complementary Currency System in the world. These local exchange networks reach a large scale during times of severe economic distress, but as large non-state initiatives, they pose a governance problem. Four types of governance systems were structured within the Argentine RT, of varying degrees of sustainability: a) loosely regulated market systems, b) hierarchies, c) associational regional networks, and d) local communities. Based on a four dimensional analytical framework, this paper discusses the rules of governance and sustainability of the governance systems in the RT. It found that some became more sustainable than others in terms of achieving combinations of scale and organisational modes