Active citizenship is a highly popular concept among Dutch policymakers. Many ministries – ranging from education, health, justice and integration to the Home office – have policies for promoting active citizenship. Among local governments, civil society and public service organisations, active citizenship is a popular concept as well. It is by all means a buzzword, expected to provide a solution to difficulties that arise out of globalisation, individualisation and democratisation (Duyvendak et al. 2010). In the area of health and social care, a new law was installed in 2007 – the Social Support Act (Wet maatschappelijke ondersteuning or WMO) – in which active citizenship figures prominently.

The central aim of the WMO is to promote participation. It particularly stresses a communitarian idea of citizenship of taking responsibility for social care in your family and your community, both as a family member and as a member of the local community and civic organisations. This communitarianism is surprising, since the Dutch patients’ movement was quite successful from the late 1960s onwards in promoting more republican and liberal notions of citizenship, stressing voice and choice respectively. How can we understand the late victory of communitarian notions of citizenship? What happened to voice and choice? In this article I will try to understand this communitarian victory by tracing the fate of responsibility, choice and voice in social care from the late 1960s onwards. I will also reflect on how it relates to views and patterns of care among Dutch citizens on the basis of my own empirical research on 25 care networks.

Late 1960s and 1970s: voice and autonomy as rights

In reconstructing the ideal of active citizenship in social care, and thereby the victory of communitarianism, we should start with the introduction of the law on health and social care, the AWBZ (Algemene Wet Bijzondere Ziektekosten, or General Law on Special Care Costs) in 1968. The WMO replaces the AWBZ in many respects, as we will see later on. Legal rights to social care services were firmly installed with the AWBZ. The law covered long-term social – back then often still residential – care for all Dutch citizens, who were automatically insured for it: the AWBZ was a collective fund. It was an extension of the health fund law (Ziekenfondswet) of 1941, the other legal coverage of medical services for which people with lower or medium incomes were automatically insured.