𝗣𝗮𝗿𝘁𝗶𝗰𝗶𝗽𝗮𝘁𝗶𝗼𝗻 𝗮𝘀 𝗮 𝗕𝗮𝗹𝗮𝗻𝗰𝗲𝗱 𝗦𝘆𝘀𝘁𝗲𝗺

An oxymoron is a figure of speech that combines two contradictory terms, like “cold fire” or “a little giant.” Participation in healthcare sometimes feels like such a contradiction. It is presented as the way to improve quality and safety while giving patients more agency, yet true ownership is often lacking in practice. Can participation and healthcare truly go hand in hand? After all, one party is inherently dependent on the other, isn’t it?

𝗧𝗵𝗲 𝗜𝗹𝗹𝘂𝘀𝗶𝗼𝗻 𝗼𝗳 𝗣𝗮𝗿𝘁𝗶𝗰𝗶𝗽𝗮𝘁𝗶𝗼𝗻
The intentions are there, but participation often remains superficial—a survey here, a feedback group there. While the value of participation is widely recognized, structural embedding is often missing. True participation requires more than just having a voice; it demands a redistribution of power and a culture where equal dialogue and collaboration take center stage.

𝗣𝗮𝗿𝘁𝗶𝗰𝗶𝗽𝗮𝘁𝗶𝗼𝗻 𝗮𝗻𝗱 𝗘𝘅𝗰𝗹𝘂𝘀𝗶𝗼𝗻: 𝗧𝘄𝗼 𝗦𝗶𝗱𝗲𝘀 𝗼𝗳 𝘁𝗵𝗲 𝗦𝗮𝗺𝗲 𝗖𝗼𝗶𝗻
Talking about participation implies that exclusion existed before. We say people are "allowed to participate again," yet we fail to acknowledge that we first created a system in which participation was not a given. Participation does not mean offering a seat at the table but rather redesigning the table itself—ensuring that healthcare users experience real influence and that their voices truly matter. Participation cannot be forced through a survey or a one-time pilot; it requires a system where give-and-take is balanced, and trust is built over time.

𝗣𝗮𝗿𝘁𝗶𝗰𝗶𝗽𝗮𝘁𝗶𝗼𝗻 𝗮𝘀 𝗮 𝗕𝗮𝗹𝗮𝗻𝗰𝗲𝗱 𝗦𝘆𝘀𝘁𝗲𝗺
Brazilian thinker Paulo Freire saw participation as a transformative process. In his critical pedagogy, he advocated for conscientização—raising awareness—and dialogue as tools to break through power structures. According to Freire, healthcare should not be a top-down process but a collaborative effort where both healthcare users and providers shape the meaning of health and well-being together.

True participation becomes possible when healthcare professionals, policymakers, and users take their rightful place within the system. Not driven by overprotection or control, but by the intent to balance autonomy and compassion. Not by removing burdens (ontzorgen), as some insurers claim, but by fostering a reciprocal interaction where care is not something given but something co-created—including the responsibility for rising healthcare costs. Only then is participation in healthcare no longer an oxymoron.