LIMITING SOLIDARITY IN THE NETHERLANDS - A 2-TIER SYSTEM ON THE WAY

Health care policy in the Netherlands has long been guided by the valu es of solidarity and equality. As a result of several forces, particul arly the scarcity of resources, the retreat of the Welfare State and t he introduction of market forces in health care, both values are incre asingly under strain. Next to solidarity and equality, freedom of choi ce and financial responsibility are playing an important role in Dutch health care. Consequently, there is a growing division in Dutch healt h care between two tiers, one basic tier giving access to a basic pack age of services and a luxury tier giving access to a higher quality of care and to services not included in the basic package. The main thes is of the article is that a two-tier system is morally justified on th e condition that the basic tier is universally accessible and is based on the value of humanitarian solidarity.