Zorglogica’s uit balans

Abstract

This book elaborates on the political and public debate on the four most prominent and stubborn problems in Dutch home care. Moreover - and with respect to that subject - the introduction of market incentives in home care is analysed. As this book will show, the introduction of market incentives is part of the so-called economic logic. Uneasily as it felt to the actors involved, market incentives have tended to disrupt the equilibrium reached by the logics that initially made up home care: the political, professional and familial logic of care.

Part I analyses the course of the political and societal debate on waiting lists, labour market, image and quality problems in home care. It examines which themes politicians and social actors (labour umbrella organisations, professional organisations, labour unions, health care insurers, patient federations etc.) have linked these four problems with; what they have brought up as their main causes and solutions; which frictions and moments of consensus can be detected between the various parties; and what shifts have taken place in these aspects between 1987 and 2002. Chapter 1 explores the waiting lists problems. Chapter 2 looks at the job shortage problem. Chapter 3 analyses the image problems. Chapter 4 discusses quality.

In part II of the book the logic of care concept is presented. Chapter 5 elaborates on the logic of care concept from a philosophical perspective: logics of care are defined as Weberian ideal types whose mixed forms function as Foucaultian discourses. Chapter 6 elaborates on how the economic logic of care ideal typically distinguishes itself from the political, professional and familial logics of care. In chapter 7 data gathering is discussed: a total of 1,121 public documents have been collected. Moreover, data analysis is discussed: a coding system is developed with which the contested, mixed forms in which the four logics of care manifest themselves in the gathered documents can be coded, operationalised and analysed.

Part III examines how politicians and social actors have reacted to the introduction of market incentives (economic logic of care) in home care. Moreover, the position is made good that the stubborn persistence of the home care problems can be partially ascribed to the tensions between logics of care and their solutions. Part III examines questions like: Do the parties believe that the economic logic of care inhibits or helps the other logics of care on the one hand and the solution of the problems in home care on the other hand? What frictions, differences of opinion and eventual moments of (explicit) agreement occur in this process? What shifts have taken place? Chapter 8 takes a look at the integral debate that political and social actors have held on the entrance of new, private suppliers to the home care market. Chapter 9 studies once again this debate. However, this time the reactions are analysed from the perspective of the professional and familial logics of care. In short, part III provides an underpinning of the position that the (stubborn) persistence of the home care problems can be partially ascribed to the (stubborn) tensions between logics of care. At least, it is exactly when synergies emerge between the economic and political logic of care, that the waiting lists drop by as much as 35 per cent after years of blows. This trend could have probably continued to a wider extent had the home care debate also sought a more fruitful relationship between the economic logic of care on the one hand and the professional and familial logics of care on the other.