Klant of zieke? Markttaal en de eigenheid van de gezondheidszorg

Abstract

Abstract: Customer or patient? The logics of market and care. While modes of ordering mix in the real world, it is helpful to sometimes disentangle them in theory so as to get a better insight in their inherent logics. In the present paper the logic of the market and that of health care are disentangled and contrasted with one another The point of departure is a miniature blood sugar measurement machine. On the market this is an attractive product, while within a care logic it is part of a process working towards a result. While sellers try to seduce their customers (with diabetes) into buying a blood sugar measurement machine, nurses and doctors try to convince their patients (with diabetes) of the necessity of using it. While on the market people are interpellated as deliberative actors of choice, in care we are called upon as practical actors engaged in self-care activities. And while the market differentiates between specific target groups, care tries to include everybody - each according to his or her abilities - in the health care team. In its attempts to seduce people into buying, the market calls upon our desires and fuels our hopes. Care, however, while encouraging us to strive after as healthy a life as possible, simultaneously tries to prepare us for the sadness that comes with the erratic character of disease. And where the care logic tells that when no positive result is to be expected, nothing heroic should be done, the market is incapable of selling 'no'. All of which implies that values are handled differently within both logics. On the market evaluation is a choice: an individual matter. The individual choices of all customers, however, are added up to form an overall 'demand'. Within care evaluation is partly a matter of the sciences and their ability to engage in outcome research. Since chronic diseases are indeed chronic, however, and health cannot be attained, another part of the evaluation is a task we collectively face. To add up individual preferences is too simple a model for handling this task. How to do it well? This is an urgent question. For what we need in health care are shared technologies and techniques, that then may be attuned to each person's specific case.