Abstract
Despite waves of budget cuts and structural reorganizations, physicians in most of Europe have not been subject to managerial controls like those that have emerged in the United States and to a lesser degree in Britain. This paper examines one of the most dramatic instances in which physicians resisted managerial and governmental control and explains recent changes in this pattern. From 1982 through 1992, Dutch hospital specialists successfully blocked efforts by governmental regulators, insurers, and hospital managers to control the specialists' activities so as to reduce hospital costs, integrate care activities, and assure quality. Gradually the specialists began to lose their budgetary and operational autonomy and signed agreements with hospitals and insurers to integrate the specialists' fees into hospital budgets. These new fiscal arrangements increase the hospital managers' economic control over specialists and create possibilities for the enhancement of other types of managerial control. The organizational and political forces behind these changes are analyzed, along with their implications for future patterns of professional control in the Netherlands and for the integration of professional and managerial functions within Dutch hospitals.
| Original language | English |
|---|---|
| Title of host publication | Health Care Providers, Institutions, and Patients |
| Subtitle of host publication | Changing Patterns of Care Provision and Care Delivery |
| Publisher | JAI Press |
| Pages | 63-79 |
| Number of pages | 17 |
| ISBN (Print) | 0762306440, 9780762306442 |
| State | Published - 2000 |
Publication series
| Name | Research in the Sociology of Health Care |
|---|---|
| Volume | 17 |
| ISSN (Print) | 0275-4959 |
Bibliographical note
Funding Information:This chapter is a revised version of a paper presented at the annual conference of the European Healthcare Management Association, Dublin, Ireland, June 1998. The first author acknowledges support for portions of this research from the Israel National Institute for Health Policy and Health Services Research and Bar-Ilan University. He also owes thanks to Eric Kormen and the staff of the National Hospital Institute in Utrecht for greatly facilitating two rounds of interviews in the Netherlands. The views expressed in the chapter are the sole responsibility of the authors and not of their employers or funding sources.
Funding
This chapter is a revised version of a paper presented at the annual conference of the European Healthcare Management Association, Dublin, Ireland, June 1998. The first author acknowledges support for portions of this research from the Israel National Institute for Health Policy and Health Services Research and Bar-Ilan University. He also owes thanks to Eric Kormen and the staff of the National Hospital Institute in Utrecht for greatly facilitating two rounds of interviews in the Netherlands. The views expressed in the chapter are the sole responsibility of the authors and not of their employers or funding sources.
| Funders | Funder number |
|---|---|
| Israel National Institute for Health Policy and Health Services Research and Bar-Ilan University |
