Continuity and Change: Comparative Case Study of Hospital and Home Care Governance in The Netherlands

This article aims to understand the evolution of health care governance in the Dutch hospital and home care sector. We pay particular attention to how institutionalized governance structures shape policy reform. Professionally-dominated governance structures are likely to continue to exist to some degree, even when new policy measures seek to introduce hierarchical control or market mechanisms in order to restrict professional autonomy. In contrast to the home care profession, the dominance of the medical profession with its high corporate power has been institutionalized into the governance structure, constraining actors' choices in ways that only permit incremental changes in hospital care.