Jan Moen, Aad de Roo and Ruud Lapré are three of the founders of Erasmus School of Health Policy & Management (ESHPM), at the time Studierichting Algemene Gezondheidszorg (SAG). We spoke with them during the Alumni Homecoming Day 2024 about what it was like to found a School, the challenges they faced and what the degree programme looked like back then. In this interview you can read a brief recap of that conversation.
How did it all start? How did the idea for a faculty like ESHPM, then called the General Health Care programme (Studierichting Algemen Gezondheidszorg; SAG), come about?
In the 1970s, the government decided to regulate the development direction of the health sector with a public planning system, particularly with the Health Care Facilities Act and the Health Care Tariffs Act. Ruud Lapré and Wim van der Mijn were involved in that legislation. To implement this planning system, knowledgeable staff would be needed in the health care field and the government. This led to the establishment of the Health Policy and Management programme in Maastricht and the SAG in Rotterdam.
Looking back, it is noticeable that at that time, health economics and health law were fully-fledged academic disciplines. However, for health care, this was not the case when it came to health organisations or health policy. There was no professor in the early years, and Jan and Aad had to find their way through trial and error.
In the second half of the 1980s, governments worldwide transitioned from planning to market mechanisms as the driving force for the health sector. The BMG became the centre for this development in the Netherlands.
Until the 1970s, the health sector in the Netherlands developed through private, pillarised network governance in a Rhineland cultural context. To the extent that the government was involved in the health sector, it was in the form of intertwined relationships with umbrella organisations and professional associations ("joint governance with the health field"). Market mechanisms have never operated in a pure form, even now there is a hybrid of market forces, planning, and network governance. Market mechanisms are losing strength and support. It would be beneficial if ESHPM further developed into an institute that shapes this hybrid form in theory and practice.
How did the process of creating the School unfold?
The positioning within the medical faculty was an expression of the old network governance, where the health field took responsibility for sector development. There was an opportunity to link the SAG/BMG with the departments of medical informatics, epidemiology, and the innovative department of medical decision-making. Dean Paul van der Maas also supported this. However, that opportunity was not seized, and eventually, the BMG was organisationally and locationally separated from the medical faculty due to university management considerations.
Describe the first days/years: what did the School look like? How many students and teachers were there?
The early years were those of a pioneering organisation with all the charm that entails. There was a lot of daily face-to-face contact between all the teachers who could initially lunch around a single table in the medical faculty's restaurant. You were close to the students; in the first year, there were 75, and we knew many by name and saw them regularly. Jan arranged a place to stay for a student within a day in the starting year. We could also arrange things for them. The best example is that suddenly ten cents had to be paid per copied scientific page at the university, making readers very expensive. So, as teachers, we made one copy and gave it to a student who had additional copies made in the city for a cent per page. Initially, we had a numerus fixus, 75 students in the first year, and then it increased to one hundred. Ideal for small-scale education. The educational philosophy also included the idea that learning effects were only responsibly distinguishable in the categories of insufficient, sufficient, and good. Ultimately, this was indigestible for an increasing number of students and teachers.
We had a preparatory committee of six people, including us, Ruud, Jan, and Aad. We formed the core of the teaching staff that needed to be expanded further. To our dismay, we saw that the vast majority of our students were women, and we realized that we needed to quickly attract an acceptable number of female teachers. As a preparatory committee, we went to Maastricht to look at problem-based education. Jan booked three rooms for our team-building, so we had to go to bed two by two. When that became clear, it caused some commotion, and Jan can tell you more about it.
What was the educational format like in those early days? Did you also work with lectures and working groups?
In retrospect, problem-based education did not sufficiently take off; Jan more or less did his doctoral dissertation on this and can tell you more about it. The influx of teachers and the faculty's growth meant that more staff accustomed to the conventional academic education model joined. And we missed an educational research department like in Maastricht that could further develop the educational model.
Are there things in health care that you thought or hoped would be resolved or improved by now?
Looking at the functioning of health organisations, nothing has been well resolved over the years; on the contrary. There is an increase in regulatory pressure and other rising overhead costs. There is an increase in control and supervision that is suffocating. And there is an emphasis on efficiency at the expense of service quality. As a director or manager, you can do little about this. It must be solved at the system level.
