The dynamics of the Dutch health care system - A discourse analysis

Kor Grit*, Wilfred Dolfsma

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

18 Citations (Scopus)


In this article, we analyze recent dynamics of the Dutch health care sector, a hybrid system of public, private and professional elements, in terms of clashing discourses. Although these elements are intricately interwoven, this does not mean that the system is stable. Most notably, since the eighties the introduction of more market elements in the health care system has been widely debated. Hospitals introduced different methods commonly used in businesses, for instance. The position of managers in the institutions of health care has become more central. A discourse analysis shows the concomitant patterns of institutional change in the health care sector. We distinguish four different discourses concerning health care: economic, political, medical-professional and caring discourses. These different discourses give rise to, for example, different views of good care, the character and position of the patient, and leadership in health care organizations - views that sometimes clash intensely.

Original languageEnglish
Pages (from-to)377-401
Number of pages25
JournalReview of Social Economy
Issue number3
Publication statusPublished - 1 Sep 2002
Externally publishedYes


  • 'Economization'
  • Discourse analysis
  • Health care management
  • Health care system
  • Institutional change
  • Modernization
  • The Netherlands


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