Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Health Care Analysis
Published in: Health Care Analysis 4/2011

Open Access 01-12-2011 | Original Article

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

Authors: Jolanda Dwarswaard, Medard Hilhorst, Margo Trappenburg

Published in: Health Care Analysis | Issue 4/2011

Login to get access

Abstract

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.
Footnotes
2
Of course it is difficult to say whether respondents all had the same idea of marketization. We did not ask our respondents for definitions. However, we asked them to give examples of marketization in their daily work and many of them came up with the same examples.
 
3
The page numbers in the references at the end of interview quotations refer to our code books (the interview transcriptions).
 
4
Good relations between hospitals and GPs were important before marketization was introduced. However, in the past, it was much more common for GPs to refer patients to the nearest hospital without further ado. These days patients are encouraged to choose a hospital and GPs are supposed to help them choose. This has made GP-hospital specialist relations more important.
 
5
Research shows that the total amount of GP care as well as the costs involved have risen steadily since the 2006 system change [25].
 
Literature
1.
Applbaum, A. I. (1999). Ethics for adversaries: The morality of roles in public and professional life. Princeton, N.J.: Princeton University Press.
2.
Bartholomée, Y., & Maarse, H. (2007). Empowering the chronically Ill? Patient collectives in the new Dutch health insurance system. Health Policy, 84, 162–169.PubMedCrossRef
3.
Bartholomée, Y., & Maarse, H. (2008). Course and impact of market reform in Dutch health care uncertain. Intereconomics, 43, 189–194.
4.
Bijl, S. (2009). Marktwerking haalt hart uit de zorg. Medisch Contact, 64, 1726–1728.
5.
6.
7.
Duyvendak, J. W., Knijn, T., & Kremer, M. (2006). Policy, people, and the new professional. De-professionalisation and re-professionalisation in care and welfare. Amsterdam: Amsterdam University Press.CrossRef
8.
Eve, R., & Hodgkin, P. (1997). Professionalism and medicine. In J. Broadbent, M. Dietrich, & J. Roberts (Eds.), The end of the professions? The restructuring of professional work (pp. 69–85). London: Routledge.
9.
Freidson, E. (2001). Professionalism. The third logic. Cambridge: Polity.
10.
Garrett, J. (2008). Fostering professional virtue in the market. Reflections on the challenges facing Chinese health care reform. Philosophy and Medicine, 96, 169–180.
11.
Krizova, E. (2008). Marketization of health care and changes in the professional status of the medical profession. In N. E. H. M. Zeegers & H. E. Bröring (Eds.), Professions under pressure. Lawyers and doctors between profit and public interest (pp. 99–111). Den Haag: Boom Juridische Uitgevers.
12.
Lako, C. J., & Rosenau, P. (2009). Demand-driven care and hospital choice. Dutch health policy toward demand-driven care: Results from a survey into hospital choice. Health Care Analysis, 17, 20–35.PubMedCrossRef
13.
Maarse, H. (2006). The privatization of health care in Europe: An eight country analysis. Journal of Health Politics, Policy and Law, 31, 981–1014.PubMedCrossRef
14.
Maarse, H., & Ter Meulen, R. (2006). Consumer choice in Dutch health insurance after reform. Health Care Analysis, 14, 37–49.PubMedCrossRef
15.
Mol, A., & van Lieshout, P. (1989). Ziek is het Woord Niet. Medicalisering, Normalisering en de Veranderende Taal van Huisartsgeneeskunde en Geestelijke Gezondheidszorg, 1945–1985. Nijmegen: SUN.
16.
17.
Okma, K. G. H. (2008). Learning and mislearning across borders: What can we (Not) learn from the 2006 health care reform in The Netherlands? Commentarty on Roseanau and Lako. Journal of Health Politics, Policy and Law, 33, 1057–1070.PubMedCrossRef
18.
Randall, G. E., & Williams, A. P. (2009). Health care reform and the dimensions of professional autonomy. Canadian Public Administration, 52, 51–69.CrossRef
19.
Rice, T., & Biles, B. (2000). Reconsidering the role of competition in health care markets: Introduction. Journal of Health Politics, Policy and Law, 25, 863–873.CrossRef
20.
Trappenburg, M. J. (1993). Soorten van gelijk. Medisch-ethische discussies in Nederland. Zwolle: Tjeenk Willink.
21.
Trappenburg, M. J. (2009). Verval van een vitale norm. Socialisme en Democratie, 66, 12–18.
22.
Vaillancourt Rosenau, P., & Lako, C. J. (2008). An experiment with regulated competition and individual mandates for universal health care: The New Dutch health insurance system. Journal of Health Politics, Policy and Law, 33, 1031–1055.CrossRef
23.
Vaillancourt Rosenau, P., & Lako, C. J. (2008). Health insurance experiments in The Netherlands and Switzerland: A rejoinder with updates. Journal of Health Politics, Policy and Law, 33, 1073–1077.CrossRef
24.
Van de Ven, W. P. M. M., Schut, F. T., Hermans, H. E. G. M., de Jong, J. D., van der Maat, M., Coppen, R., et al. (2009). Evaluatie Zorgverzekeringswet en Wet op de zorgtoeslag. Den Haag: ZonMW.
25.
26.
Metadata
Title
The Doctor and the Market: About the Influence of Market Reforms on the Professional Medical Ethics of Surgeons and General Practitioners in The Netherlands
Authors
Jolanda Dwarswaard
Medard Hilhorst
Margo Trappenburg
Publication date
01-12-2011
Publisher
Springer US
Published in
Health Care Analysis / Issue 4/2011
Print ISSN: 1065-3058
Electronic ISSN: 1573-3394
DOI
https://doi.org/10.1007/s10728-011-0166-z

Other articles of this Issue 4/2011

Health Care Analysis 4/2011 Go to the issue

Original Paper

European Health Systems and the Internal Market: Reshaping Ideology?

Original Article

Switching Health Insurance Plans: Results from a Health Survey

Original Article

Government Influence on Patient Organizations

Original Article

The Meaning of Body Experience Evaluation in Oncology

Original Paper

Public Accountability and Sunshine Healthcare Regulation