Mind the Gap: Mental Health and a Regulated Insurance Market in the Netherlands
In the Netherlands healthcare is organized by a regulated insurance market. This combination of state and market creates tensions that are explored in this short film, in which psychotherapists reflect on their difficult position in the system.
In the Netherlands, citizens are under a legal obligation to insure themselves through a private insurer. Health insurance is thus entangled with both the realm of the state and the realm of the market. When we explore how the financial settlement of healthcare is organized, this brings to light the downside of both privatization and state institutions.
Psychotherapist in a regulated market
In this short documentary, Brechtje Boeke and I gave the floor to four psychotherapists who wanted to share the difficulties they face as therapists trying to operate in this rather complex system. They tell us about their experiences and frustrations about the way healthcare is organized and especially their own role as professionals in relation to the position of the health insurer. Psychotherapists feel they need to defend and guard their profession against the influence and pressure of the health insurers.
Crumbling against insurers
When expressing concerns, people reveal their expectations about the state and the market, but this also gives insight into the power relations and how people – as professionals and citizens – position themselves or are positioned in relation to each other. Questions about who can organize care more efficiently, what the relation is between cost and quality, or what should or should not be covered by the insurer also make explicit the characteristics commonly ascribed to either market or state, and the associated values.
Mind the gap
The gap is then not only about the fascinating healthcare arrangement that combines market and state involvement, but also about how the healthcare system ought to work, and how it works in practice according to different people. The regulated market forces in healthcare create (sometimes inconvenient) double roles. A citizen becomes both patient and consumer, the professional is both specialist and entrepreneur, and the insurer is both a business and responsible for what used to be part of the welfare state. These roles come with rights and obligations, responsibilities, expectations, and wishes. My PhD research includes the perspective of health insurers and how they navigate in this system; in the current film, however, the focus is specifically on the perspective of the psychotherapist.
This documentary is part of ongoing fieldwork on health insurance in the Netherlands by Nikkie Buskermolen. The research is part of the Moralising Misfortune project, principal investigator Erik Bähre, funded by the European Research Council (ERC) under the Horizon 2020 Research and Innovation Programme (Grant Agreement No. 682467).