Choices in health care: a contribution from The Netherlands

In this paper it will be argued that choices in health care are necessary, desirable and just. An important choice that each society has to make, is: what basic services should be available to everybody independently of an individual's purchasing power? The Dutch Government Committee on Choices in Health Care advised the use of four criteria: basic care must be necessary, effective, efficient and cannot be left to the individual's responsibility. Because important decisions with respect to the second criterion-the effectiveness of care-are made by physicians in the consulting room or at the operating table, physicians do have a primary responsibility in making the right choices.