Abstract
The Covid-19 pandemic has put policy systems to the test. In this paper, we unmask the institutionalized resilience of the Dutch health care system to pandemic crisis. Building on logics of crisis decision-making and on the notion of 'tact', we reveal how the Dutch government initially succeeded in orchestrating collective action through aligning public health purposes and installing socio-economic policies to soften societal impact. However, when the crisis evolved into a more enduring one, a more contested policy arena emerged in which decision-makers had a hard time composing and defending a united decision-making strategy. Measures have become increasingly debated on all policy levels as well as among experts, and conflicts are widely covered in the Dutch media. With the 2021 elections ahead, this means an additional test of the resilience of the Dutch socio-political and health care systems.
Highlights
The Covid-19 pandemic has put policy systems to the test
We examine how policy decision-making happened in the unfolding Covid-crisis in the Netherlands, building on these four logics
We describe the institutional setting of the Dutch health care system, and how the Covid-crisis plays out in the midst of legal requirements and both traditional and new institutionalized arrangements of governing health care and public health
Summary
The Covid-19 pandemic has put policy systems to the test. The acute crisis of the virus outbreak in the late winter of 2020, which resulted in an overflow of severely ill patients in hospitals suffering from yet unknown illnesses, has evolved into a more enduring crisis that challenges the sustainability of national political-economic and health care systems (Bal et al, 2020; Boin et al, 2020a). In the Netherlands, the virus outbreak has moved the state in the centre of socio-political regulations and health care decision-making This contrasts with the shift to decentralization and regulated competition that has characterized Dutch health care policies in the past three decades. Public health implies a centralized approach, the decentralized and competitive governance logic of the Dutch health care system evokes divergent interests This layered and fragmented institutional infrastructure, we argue in this paper, has put the central government in a difficult position to stipulate stringent policy measures to control the virus outbreak. The logic of appropriateness, on the contrary, underscores decision makers’ ability to read, and respond to ‘cues and prompts’ based on shared repertoires and institutionalized roles (March, 2006: 203) It relies on elements of tradition, rules, routines, identity and emotion, which is both deliberate and future-oriented. In the empirical sections that follow, we deepen the analysis through the discussion of three topics that were key to crisis decision-making in the Netherlands: the alignment of hospital care; the negotiation of scarcity and the contested role of experts and expertise in policy-making
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