Kim Putters advocates a new social contract for healthcare

On 15 September Kim Putters delivered his inaugural lecture “Signed – Paving the way to a new social contract in healthcare”. In so doing, he formally accepted his endowed chair “Policy and governance of care in a changing welfare state” at Erasmus School of Health Policy & Management, Erasmus University Rotterdam. In his inaugural lecture, Kim Putters explored and advocated the need to take a fresh look at the organisation of solidarity surrounding the social risks between the sick and the healthy and those on high incomes and those on lower incomes, in order to tackle social dissatisfaction and ensure that the basis of the system, i.e. the solidarity, is retained.

Kim Putters concluded his lecture on an optimistic note by considering how - in a renewed way - the risks inherent in healthcare could be shared differently, for example in healthcare cooperatives; whereby citizens could arrange and organise matters themselves by, for instance, investing in lifelong housing; how participation and control could be allocated; how scientific knowledge should be applied for the benefit of local social policy, and central government and municipalities be mutually obliged to conclude other agreements.

The need for the right (or good) healthcare

Putter asserts that the basis of our welfare state is solidarity between the sick and the healthy, and between those on high incomes and those on lower incomes. However, increasingly often people believe they are benefiting less from this solidarity, they are not receiving the right form of help or could probably arrange it better themselves. This raises the level of dissatisfaction. At the same time, the problems and numbers of vulnerable groups continue to mount. Consequently, the lack of trust in institutions is growing. Moreover, people have less confidence that politicians, care administrators and doctors are doing things “well”, according to Putters.

Decentralisation in the healthcare sector will only succeed if there is a renewed social contract

In his inaugural lecture, he makes a link between recent decentralisation in the healthcare sector and the decline in solidarity. According to Putters, decentralisation has, until now, mainly related to what the government expects of it citizens, and the question he poses is: what can the citizens actually expect from the government? In addition, he argues that it is now time for the government to provide some clarity about, inter alia, the basic standards for good healthcare, the control exercised by both citizens and municipalities, as well as the scope for cooperatives without too much bureaucracy. Without the renewed social contract he is advocating in his lecture, he deems it highly improbable that decentralisation will succeed in the long term. While Putters acknowledges that there are still areas where the current social contract operates successfully, for example agreements made during kitchen table conversations, his view is that, on its own, it no longer always results in good care. Consequently, he believes greater effort must be made to ensure a renewed social contract is achieved.


More information

In addition to being a professor at Erasmus University, Kim Putters is also director of the Netherlands Institute for Social Research.

The inaugural lecture book can be downloaded here (in dutch).
For more information, please contact ESHPM’s department of Marketing & Communications at

Compare @count study programme

  • @title

    • Duration: @duration
Compare study programmes