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A Dutch window into the development of a two tier healthcare system

BMJ 2010; 340 doi: (Published 28 April 2010) Cite this as: BMJ 2010;340:c2330
  1. Joe V Guadagno, multiple sclerosis fellow, VU Medical Centre, Amsterdam,
  2. Chris H Polman, professor of neurology, VU Medical Centre
  1. Correspondence to: J V Guadagno joseph.guadagno{at}

    May we fire a warning shot across the bows—to use a maritime analogy, as is common in the Netherlands—with regard to the renegotiation of contracts in the next phase of the development of independent sector treatment centres? These centres were originally designed (partly) to introduce “apparent” healthy competition into the “inefficient” NHS in England. We say “apparent,” as we would like to emphasise that, contrary to what’s being touted, when it comes to competition it is certainly not a level playing field, to use a more British expression (as they are all level here in the Netherlands). This was brought home to us in a vivid and extreme example while reviewing a patient at the VU Medical Centre in Amsterdam, where private healthcare providers have been in competition for a number of years.

    A man with rather benign but definite multiple sclerosis was re-referred to the VU’s multiple sclerosis centre at the request of a private orthopaedic clinic. He had been …

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