This article investigates the scope and effects of enhanced consumer choice in health insurance that is presented as a cornerstone of the new health insurance legislation in the Netherlands that will come into effect in 2006. The choice for choice marks the current libertarian trend in Dutch health care policymaking. One of our conclusions is that the scope of enhanced choice should not be overstated due to many legal and non-legal restrictions to it. The consumer choice advocates have great expectations (...) of the impact of enhanced choice. A critical analysis of its impact demonstrates that these expectations may not become true and that enhanced consumer choice should not be perceived as the ‘magic bullet’ for many problems in health care. (shrink)

In the Netherlands, current policy opinion emphasizes demand-driven health care. Central to this model is the view, advocated by some Dutch health policy makers, that patients should be encouraged to be aware of and make use of health quality and health outcomes information in making personal health care provider choices. The success of the new health care system in the Netherlands is premised on this being the case. After a literature review and description of the new Dutch health care system, (...) the adequacy of this demand-driven health policy is tested. The data from a July 2005, self-administered questionnaire survey of 409 patients (response rate of 94%) as to how they choose a hospital are presented. Results indicate that most patients did not choose by actively employing available quality and outcome information. They were, rather, referred by their general practitioner. Hospital choice is highly related to the importance a patient attaches to his or her physician’s opinion about a hospital. Some patients indicated that their hospital choice was affected by the reputation of the hospital, by the distance they lived from the hospital, etc. but physician’s advice was, by far, the most important factor. Policy consequences are important; the assumptions underlying the demand-driven model of patient health provider choice are inadequate to explain the pattern of observed responses. An alternative, more adequate model is required, one that takes into account the patient’s confidence in physician referral and advice. (shrink)

The adversary professions--law, business, and government, among others--typically claim a moral permission to violate persons in ways that, if not for the professional role, would be morally wrong. Lawyers advance bad ends and deceive, business managers exploit and despoil, public officials enforce unjust laws, and doctors keep confidences that, if disclosed, would prevent harm. Ethics for Adversaries is a philosophical inquiry into arguments that are offered to defend seemingly wrongful actions performed by those who occupy what Montaigne called "necessary offices."Applbaum (...) begins by examining the career of Charles-Henri Sanson, who is appointed executioner of Paris by Louis XVI and serves the punitive needs of the ancien régime for decades. Come the French Revolution, the King's Executioner becomes the king's executioner, and he ministers with professional detachment to each defeated political faction throughout the Terror and its aftermath. By exploring one extraordinary role and the arguments that can be offered in its defense, Applbaum raises unsettling doubts about arguments in defense of less sanguinary professions and their practices.To justify harmful acts, adversaries appeal to arguments about the rules of the game, fair play, consent, the social construction of actions and actors, good outcomes in equilibrium, and the legitimate authority of institutions. Applbaum concludes that these arguments are weaker than supposed and do not morally justify much of the violation that professionals and public officials inflict. Institutions and the roles they create ordinarily cannot mint moral permissions to do what otherwise would be morally prohibited. (shrink)