Frame stories: Stakeholder Prospects for the Dutch health care sector

Background: Stakeholders in the Dutch health care sector published prospects for the future. Since stakeholders are important actors in policy making, yet their prospects have not received much attention, this study analyses their prospects. This study aims to gain insight in how the stakeholders in the Dutch health care sector envision the future of health care in the period 2015-2025? The answer to this question is framed by the following four questions: 1) How is the future of health care envisioned with specific regard to quality, availability, accessibility and affordability by the stakeholders? 2) How do stakeholders envision their own role in the future health care? 3) How have stakeholders applied methodology from futures studies in their prospects? 4) Given that uncertainty about the future is inevitable, how do the stakeholders address uncertainty about the future in their prospects? Methods: 9 prospects from 18 stakeholder organisations in total, concerning the period 2015-2025 were subject to Grounded Theory analysis. Inductive and deductive coding resulted in axial coding networks for each of the research questions. Deductive coding was based on results of preliminary inductive coding and on the research questions. Through analysis of the networks each research question was answered. Results: The results show that stakeholders remain committed to the four public values but differ in their view how to uphold the values, facing pressures from increasing demand and decreasing personnel supply. Stakeholder roles will be affected by an independent and involved patient, leaving the provider to take a more coaching role. Challenges can be expected regarding task redistribution to lower levels and integral care provision. Ambiguity exists regarding the potential of redistribution of care to informal care givers. Moving to the construction of the prospects, the results show stakeholders primarily used forecasting but mixed this with room for future uncertainty and departed from normative viewpoints. Uncertainties were primarily reduced but in some cases acknowledged. Acknowledgement of uncertainty was found to enhance credibility. Normative uncertainties were not discussed. Conclusion: The majority of differences in the content were linked to implementation of views. Increased patient responsibility will affect the role of providers. The prospects can be characterised as ‘subjective forecasts with room for future uncertainties