Vrije artsenkeuze: recht of macht?

This article outlines the historical development of the principle of patients’ free choice of doctor in the Netherlands. Far from being the result of debates on patients’ rights, this principle was used instead as an instrument by the medical profession to gain a foothold in the power relations between doctors and sickness funds back in the early 20th-century. This development created a medical power bloc that lasted for most of that century and forced sickness funds and private insurers to start organizing in this fashion too. Therefore, when the new market ideology of introducing competition in health care was introduced in 1987, the fields of health provision and insurance were already defined by a high degree of cartelization. These relations lingered even after the introduction of regulated competition in 2006. Knowledge of this history therefore leads to a better understanding of current debates and problems in the organization of Dutch health care.

Conflict of interest and financial support: none declared.

Samenvatting

In dit artikel wordt de geschiedenis van de vrije artsenkeuze in Nederland uit de doeken gedaan. In tegenstelling tot wat vaak gedacht wordt, komt dit concept historisch gezien niet in de eerste plaats voort uit een begaan zijn met de patiënt en diens recht om zijn arts te kiezen. De artsenkeuze moet eerder gezien worden als een machtsmiddel dat aan de basis lag van de complexe verhoudingen die de afgelopen eeuw tussen zorgverleners, verzekeraars en de overheid zijn gegroeid.