Sluipend kwaliteitsverlies in de geestelijke gezondheidszorg professionals over de gevolgen van marktwerking

In order to facilitate the creation of a regulated market, Diagnostic Treatment Combinations (DBC’s in Dutch) have been introduced in Dutch mental health care in 2008. DBC’s are developed to distinguish and price the ‘products’ of health care, in order to make comparison and competition between health care providers possible. In this qualitative study we analyzed mental health care professionals experiences with the DBC-system. We focused on two questions: (1) what does the DBC-system and the related introduction of marketization of mental health care mean for professionals? and (2) how do professionals cope with the DBC-system in their daily practices? We found that the logics of the market and bureaucracy, both incorporated in the DBC-system, often conflicted with the values and ethics of mental health care professionals. Mental health professionals experience deterioration of professionalism and quality of care. They were coping with conflicting values by non-compliance with rules and pragmatic use of the DBC-system. It is argued that the efforts of professionals to protect the quality of their work might actually lead to invisibility of the problems they encounter, which reinforces the policy they criticize.