Policy Making on Reserves of Dutch University Hospitals: A Case Study

Organizations in the health care sector are increasingly managed and judged on the basis of economic criteria. Because they are faced with growing risks, reserves need to be sufficiently high. This paper entails a case study on policy making regarding reserves in a particular segment of the Dutch health care sector, i.e. university hospitals. After describing the various major risks of health care organizations, the three stages of the case study will be presented. First, we developed, in collaboration with experts from the university hospitals, a model for establishing sufficient reserves. Second, an advisory committee of the Dutch government formulated guidelines for policy making on this issue. Finally, after the recommendations of this committee became the basis for policy making on reserves, we examined the changes in the actual reserve policy of the university hospitals. The way in which health care organizations can cope with their perceived risks by establishing sufficient reserves or by taking other actions is hardly covered in the literature on public sector or not–for–profit organizations. This paper endeavours to raise relevant questions and to suggest preliminary answers by describing and critically appraising a case study on this subject.