Negotiating fees for medical specialists in The Netherlands

This article presents an analysis of the negotiations on fees for medical specialists in the Netherlands since the introduction of the Law on Health Care Charges (WTG) in 1982. The peculiar position of the medical specialists and the institutional setting of the negotiations have produced a complex decision making process. Negotiations between the government and the health insurers on the one hand and the association of medical specialists on the other hand have been dominated by deep conflicts which were sometimes settled by temporary "peace contracts'. Attention is paid to the policy network, to the participants in the network and their principal goals, to the strategic use of the WTG by each participant and to the political effectiveness of the WTG. The article ends with a short overview of some recent developments and a sketch of three alternative scenarios on the future of the payment for specialist care.