[The organization of psychiatry in the Netherlands and Belgium: who is an example for whom?]

Abstract

Background: The medical profession such as that of a psychiatrist is a profession with three essential characteristics (specialist care, autonomy and formal recognition, and professional ethics). The 21st century is characterized by bureaucratization and marketization of healthcare. Medical sociologist Friedson described three forms of logic: the logic of the professional, the logic of bureaucracy and the logic of the market.

Aim: To test the position, autonomy and effectiveness of the psychiatrist from a historical perspective. To assess developments in Dutch and Belgian psychiatry and make a comparison.

Method: Two psychiatrists from Belgium and the Netherlands mention relevant developments. It is examined which form of logic is followed in these developments.

Results: The logic of the professional applies to quality and further training, but is threatened by some Boards of Directors and the position of the Dutch psychiatrist. The logic of bureaucracy dominates in the new legislation on compulsory healthcare in the Netherlands. Finally, the powerful health insurers illustrate the logic of the market.

Conclusion: The logics of bureaucracy and the market take the upper hand in the Netherlands, to the detriment of the logic of the professional. Extensive bureaucratization and the power of health insurers are not desirable developments for Belgium. Belgians should urgently consider the options for compulsory treatment and mandatory quality and further training.