title: The impact of the introduction of market incentives on occupational health services and occupational health professionals: experiences from The Netherlands.
abstract: OBJECTIVE
  This paper describes the reform of the regulations on safety and health in the Netherlands towards a more competitive market and its impact on occupational health services (OHSs) and the health professionals over the period 1994-2005. Aims are to identify the crucial factors that bring about the intended effects (such as lower disability rates) and to evaluate the outcomes from the perspective of the occupational health professional. The paper contributes to the discussion of how the professionals could define and contain their professional identity and credibility in competitive circumstances.
  
  
  METHODS
  Open interviews were completed with 12 key persons and secondary analyses were made on documents and various monitors.
  
  
  RESULTS
  The reform changed the OHS safety market fundamentally. OHSs were transformed from medium sized regional units into business organizations mostly operating on a national level. Private insurance companies became key players. Only after the development of an effective social infrastructure, however, intended effects (lower absenteeism and disability) occurred. Occupational health professionals were initially opposed but by redefining their professional domain and identity, they finally succeeded in gaining negotiating power in order to preserve and develop expertise and professional integrity.
  
  
  CONCLUSIONS
  The effectiveness of the introduction of market incentives depends strongly on their social embeddedness. Health professionals should adapt their strategy to the conditions of the competitive market, in order to preserve a credible and professional identity.
authors.affiliation: Department of Public and Occupational Health, VU University Medical Centre, Amsterdam, The Netherlands. hn.plomp@vumc.nl
authors.forename: Harmen Nico
authors.initials: HN
authors.lastname: Plomp
mesh_terms: D004465:Economic Competition; D018166:Health Care Reform; D006282:Health Personnel; D007407:Interviews as Topic; D009042:Motivation; D009426:Netherlands; D009786:Occupational Health Services / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D015397:Program Evaluation