Navigating conflicting expectations in addressing healthcare scarcity: a q-methodology study on the Dutch National Health Care Institute.

Item request has been placed! ×
Item request cannot be made. ×
loading   Processing Request
Read More Add to Saved list
  • Additional Information
    • Publication Information:
      Ahead of Print
    • Source:
      Publisher: Cambridge University Press Country of Publication: England NLM ID: 101247224 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1744-134X (Electronic) Linking ISSN: 17441331 NLM ISO Abbreviation: Health Econ Policy Law Subsets: MEDLINE
    • Publication Information:
      Original Publication: Cambridge : Cambridge University Press, c2006-
    • Abstract:
      In many European countries, semi-autonomous agencies have been created in health policy to safeguard general public interests. In executing their tasks, these agencies need to deal with conflicting expectations. Particularly avoiding the risk of regulatory capture and aligning with parent ministries are frequently studied challenges, even more so when complex issues such as scarcity are at stake. In this paper, we use q-methodology to provide a thorough overview of the debate regarding the role of an important agency in the Dutch healthcare system; the National Health Care Institute (Zorginstituut Nederland). We conducted 41 q-interviews with agency employees, evaluators, regulatees, ministry employees, health policy experts, members of its advisory committees, and peer agencies. We identify three viewpoints on what the agency should focus on. These are on societally relevant issues, strict package management, and efficient organisation of care. In doing so, our study shows how agencies are pulled in different directions by conflicting expectations. We show that this can be problematic because it complicates a clear role of the agency that allows addressing such issues. We thereby contribute to theories on agencies' complex relations with their external environment such as regulatory capture, tripartism, reflexive regulation, legal boundaries, and stewardship theory.
    • Grant Information:
      Zorginstituut Nederland
    • Contributed Indexing:
      Keywords: conflicting expectations; q-methodology; scarcity; semi-autonomous agencies; the Netherlands
    • Publication Date:
      Date Created: 20241009 Latest Revision: 20241009
    • Publication Date:
      20241010
    • Accession Number:
      10.1017/S1744133124000136
    • Accession Number:
      39384579