Policy under Construction

In the past decades, the Dutch society, and the way it is governed, has changed. Market-mechanisms have been introduced and society has obtained a more active role. Similar changes are noticeable within the Dutch health care sector. In line with the developments and in line with a desire to resolve a gap between policy and public, the system of Personal Care Budgets was introduced. With the introduction of the Personal Care Budgets, society was able to participate in the health care sector. Personal Care Budgets were supposed to be an attractive substitute for Care in Kind. However, as time passed, the system started to show shortcomings. According to the Dutch government, it was inevitable to change the policy. Society did not accept the changes and accused the government of enlarging an input-oriented as well as an output-oriented gap between public and policy. This research takes a closer look at this situation by means of the following research question: To what extent did the policy changes concerning the Personal Care Budgets of January 2012 affect the gap between policy and public and what can be learned from the past? Two research methods are used to answer the research question; interviews and a document studies. The information gathered in the interviews, scientific literature and Dutch chamber documents is analyzed by the method of encoding, resulting in a conclusion as follows: The policy changes concerning the Personal Care Budgets affected the input-oriented gap only to a small extend. At certain times, the government averted discussion, but she did not ignore Per Saldo throughout the entire process. The policy changes did not affect the output-oriented gap. What lessons can be learned? As the accusations coming from society are proved invalid, it appears that the issues concerning the policy measures were solved. However, that is not the case. In the case of the policy changes concerning the Personal Care Budgets, the degree of resistance was extreme. A recommendation towards the government is to take such high degrees of resistance seriously. The government should no longer avert discussion, has to look at alternatives and inform society on why given solutions are the best solutions and why alternatives do not fit. When the government had acted upon the high degree of resistance in this specific situation and had taken a closer look at the measures, a long and intensive struggle could have prevented. The Dutch government has made the wrong decision. The policy measure offers a solution to issues that are not of such importance or which could easily be solved otherwise. I plead for preservation of the system of Personal Care Budgets in the Netherlands. The need for care for patients will continue and that, in combination with Personal Care Budgets being cheaper than providing Care in Kind, makes it important that the system will be maintained. Two adjustments are necessary. First, to ensure that patients receive care that fits their wants and their needs, the current system has to be sorted out. Secondly, a new role for care offices has to be properly framed and has to be actually implemented.