Health care and welfare provision have always been complex phenomena – people who tend to be professionals who are caught between private situations, community interests and public values deliver soft services to vulnerable, weak, or powerless individuals. Over time, various types of governance have been introduced in order to organise and provide complex care and welfare. These governance systems have unavoidably been hybrid. Because health care and welfare are service delivery issues; because they involve vulnerable clients and professional providers; and because individual, community and collective interests collide – or conflict – it has proven difficult to leave care and welfare provision exclusively to the state, the market, civil society or individuals. It has always required distinctive combinations of these spheres, especially in small and heterogeneous countries like the Netherlands, which had to introduce intricate, hybrid mechanisms to organise collective action (e. g., Hupe & Meijs 2000).

This does not mean that all of these spheres have always been equally active, or that governance systems have always been balanced. In specific periods, history shows us, specific spheres tended to dominate care and welfare. In previous centuries, the church took an interest in organising services for the sick, the troubled and the poor (e.g., Tuchman 1980). In later periods, municipalities, guilds and wealthy citizens organised or financed service provision (Frijhoff & Spies 1999), due to moral obligations and practical reasons – the wealthy paid for and profited from stable social orders. In the industrial era, private companies took part in health care and welfare settlements, and states became increasingly active. Dutch health care and welfare providers became ‘statist’ (verstatelijkt) organisations especially during the second half of the 20th century. Embedded within extensive state-based welfare arrangements, they were increasingly financed by public means and therefore controlled through public accountability regimes. These arrangements were bureaucratic as well as professional – in large, bureaucratic organisations, professionalism on the work floor was maintained (see Clarke & Newman 1997).

By the end of the 20th century, state-based welfare settlements were considered too costly, and both market-oriented and businesslike models began to dominate (e.g., Clarke & Newman 1997). In contemporary neoliberal times, health care and welfare have been subjected to businesslike performance regimes (with businesslike managers) and market-oriented control logics.