The Dutch health care system has both in financing and health care provision a hybrid nature. Financing is realized through a mixture of public and private insurance executed by care insurers with a (semi) private status. Health care is provided through professions and institutions that function to a large extent as not-for-profit private entities within a highly regulated context, reimbursed through a mixture of budgetary, pro-capita and fee-for-service schemes. The role of the state has changed over the years. Roughly one can claim that in the fifties and sixties the welfare state was created, in the seventies and eighties government tried to control the growing costs through managing the structure of health care by planning regulation and in the nineties the processes within the system (regulated market) were the main policy paradigm. At the turn of the century the steering paradigm is shifting towards the input (needs assessment) and outcome (performance measurement) of the system. Not only production and costs, but also performance in terms of health outcomes and consumer satisfaction are deemed relevant management factors…