COST-CONTAINMENT AND THE RIGHT TO HEALTH-CARE

This article addresses the question of how cost containment programmes affect the right to health care in The Netherlands. A distinction is made between three different dimensions of the right to health care: h ealth care entitlements, need assessment and enforceability. The analy sis starts with a discussion of entitlements in social and private hea lth insurance and a brief overview of how decisions on entitlements ar e made. Next, it is shown how the search for cost containment has infl uenced health care entitlements in Dutch health care (e.g. critical sc reening of entitlements) and has resulted in a need for more stringent guidelines for need assessment to use health care resources more effi ciently. The growing gap between the growth rates in health care deman d and the resources for health care points to the creation of enforcea bility problems in health care (waiting lists). The final section disc usses the question of whether Dutch health care is moving towards a tw o-tier system. Throughout the analysis attention is given to the polit ical dimension of the debate on health care entitlements, need assessm ent and the enforceability of entitlements.