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.