ABSTRACT
Over the past decades there has been increasing criticism in the Netherlands of the accessibility, acceptability and quality of healthcare. At the same time, the Dutch health system has become ever more costly, and the growing number of chronically ill patients has contributed to the fear of unsustainability in terms of affordability (De Nationale Denktank, 2006; RIVM, 2010). Because it seems difficult to solve these long-standing problems, either by policy interventions, care measures undertaken by health professionals or new small-scale care initiatives, these problems have been labeled “persistent problems” (see e.g. Dirven et al., 2002; Rotmans, 2005). Persistent problems are believed to be structural, inherent to the current health system, and therefore seen as system deficits. Accordingly, they are presented as both the reason for and the legitimization of the need for a system innovation or transition (see e.g. Grin et al., 2010).
