Who is responsible for health care? Neoliberal policies since the 1970s seem to place this responsibility increasingly on the individual, in a process that is called responsibilization. The recent literature on neoliberalism, however, has questioned the preference of free-market liberalism for individual responsibility and shows how neoliberals often made common cause with communitarian conservatives on social policies. Melinda Cooper, for instance, has argued in her book Family Values that free-market liberals and social conservatives in the US both identified the family as a ‘wholesale alternative to the 20-century welfare state’. This article investigates whether this coalition of neoliberals and social conservatives, who agree on the importance of familial solidarity in addition to market freedom, has also played a role in the making of Dutch health care policies. By tracing how responsibility for long-term care has been allocated in the postwar Netherlands in the specific case of children with (cognitive) disabilities, the author will show how ‘the family’ has increasingly been embraced by policymakers as the main responsible party. This is remarkable because the Dutch postwar welfare state sought to loosen family ties in favour of individual arrangements. However, attempts by different stakeholders to deinstitutionalize Dutch health care during the 1990s unintentionally moved the state's responsibility for long-term care not so much onto individuals as onto families.

中文翻译：

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从机构到家庭？荷兰战后长期护理政策中认知障碍儿童责任分配的变化


谁负责医疗保健？自 1970 年代以来的新自由主义政策似乎越来越多地将这种责任放在个人身上，这一过程被称为责任化。然而，最近关于新自由主义的文献质疑了自由市场自由主义对个人责任的偏好，并展示了新自由主义者如何在社会政策上经常与社群主义保守派达成共识。例如，梅琳达·库珀（Melinda Cooper）在她的《家庭价值观》（Family Values）一书中指出，美国的自由市场自由主义者和社会保守主义者都认为家庭是“20世纪福利国家的批发替代品”。本文调查了这个新自由主义和社会保守派的联盟，他们同意除了市场自由之外，家庭团结的重要性，是否也在荷兰医疗保健政策的制定中发挥了作用。通过追溯战后荷兰在（认知）残疾儿童的特定情况下如何分配长期护理的责任，作者将展示“家庭”如何越来越多地被政策制定者视为主要责任方。这很了不起，因为荷兰战后福利国家试图放松家庭关系，以支持个人安排。然而，在 1990 年代，不同的利益相关者试图将荷兰医疗保健去机构化，无意中将国家对长期护理的责任转移到了家庭身上，而不是个人身上。