The shadow of the future: institutional change in health care

Lessons can be learned about the fate of the steps that have followed the passage of health care reforms. The Netherlands provides a case in point. If one looked at health system reform plans only as outlined in government policy notes and white papers, one would expect to find significant changes....

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Bibliographic Details
Published in:Health Affairs 1994, Vol.13 (5), p.137-148
Main Author: Groenewegen, P P
Format: Article
Language:English
Subjects:
Attitude to Health
Catchment areas
Changes
Competition
Economic Competition
Health care
Health care expenditures
Health care industry
Health care policy
Health Care Reform - economics
Health Care Reform - legislation & jurisprudence
Health insurance
Health Policy
Hospitals
Implementation
Implementations
Institutional change
Insurance
Insurance coverage
Interest groups
Legislation
Monopolies
National Health Programs - economics
National Health Programs - legislation & jurisprudence
Netherlands
Nonprofit organizations
Organizational Innovation
Politics
Public health
Reforms
Risk
Social conditions & trends
Studies
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Summary:Lessons can be learned about the fate of the steps that have followed the passage of health care reforms. The Netherlands provides a case in point. If one looked at health system reform plans only as outlined in government policy notes and white papers, one would expect to find significant changes. However, it is important to realize that the shadow of the future, as outlined in these policy proposals, prompts responses from interest groups. These responses modify the institutional structure of the system before actual changes have even been attempted by government. Thus, the conditions for successful implementation of new policies are altered. Three streams of institutional change can be distinguished: 1. responses to increased functional rationality in the larger society, 2. changes in the dominant belief system regarding health care, and 3. changes in response to actual policy implementation in health care.
ISSN:0278-2715
1544-5208
DOI:10.1377/hlthaff.13.5.137