Abstract

The 2006 health care reforms in the Netherlands were aimed at improving the affordability, accessibility, and quality of health care, as well as freedom in health care. However, the reality is that since the reforms (which include the privatisation of health-care insurance), costs have further increased and accessibility has decreased while freedom of choice has declined. The reforms reduced freedom, while increasing costs and reducing accessibility. The aim of this thesis is to investigate whether these issues stem from a deeper (Utilitarian) philosophical foundation of how health care is currently funded and to propose a mode of funding founded on Aristotelian principles that would be in support of freedom without adversely affecting (or even improving) costs, accessibility and quality The analysis of the system of Managed Care (in Chapter 2) and its implementation in The Netherlands (in Chapter 3) suggests that the rising costs of health care may be related at least in part to the utilitarian foundation of this system (with its utility-maximising consumer and its profit-maximising producer who, in an oligopoly like the health-care market, is able to generate super-normal profits), in part to the heavy administrative load associated with Managed Care, and in part due to contracting practices. All of which also restricts freedom of choice. Aristotle's ethics, specifically his \textit{Nicomachean Ethics}, underlines the importance of freedom (of deliberation) as the quintessential requirement for eudaimonia. If this were taken as the philosophical foundation for the health care system, then patients and health care providers would be able to make informed choices that align with their personal goals and values. This freedom of deliberation stands in stark contrast with protocolisation, standardisation and homogenisation that Managed Care brings. Such a system creates a 'monoculture' in which it is difficult to find discernible differences in price and quality, making it equally difficult to identify possible trade-offs between the two and implications of such trade-offs. In Chapter 4 I propose a mode of funding Dutch health care that safeguards freedom of deliberation in health care that would be in line with the Dutch socio-economical environment and political system. The proposed Health Care system is a universal health care system with a single-payer that covers all health care expenses; where medical decision/treatments are made autonomously by client and practitioner without meddling/pressure/ruling by other parties who are not practising health care; where the funding of health care is a matter of transparent deliberation between all parties and a part of political discourse. By prioritising freedom of deliberation, the proposed reforms address the limitations of Managed Care's utilitarian philosophy and offers a more human-centred approach to health care. A system that is based on Aristotelian philosophy creates an environment that encourages open and honest communication between all parties involved and is expected to improve all relevant aspects of the Dutch health care system and health itself. The suggested reforms are far reaching and may seem unrealistic. Its proper functioning would indeed require substantial social reform in all spheres of social life (economic, legal-political, and cultural), though they remain entirely in-line with Dutch socio-econo-political reality. In conclusion, this thesis argues that the Netherlands' health care reform should prioritise freedom of deliberation (the fundamental requirement for eudaimonia). As such individuals' well-being and values are prioritised, which is expected to have beneficial effects including reducing costs and improving the overall quality of care without diminishing access to it. Free deliberation and subsequent cooperation are thought to have more potential than competition.