Societal challenges are increasingly requiring cooperation and solutions on a regional scale. The recently formed metropolitan regions around Amsterdam, Rotterdam-The Hague and Eindhoven are examples. This essay serves as the introduction to a symposium on regionalization and the substantive and institutional questions that regionalization raises. It deals with the growing differences between regions and the call for a differentiated response. It also discusses the drivers for regional cooperation and the constraints of focusing on administrative structures. The essay exposes a number of tensions regarding the external profiling of regions, the benefits of regional cooperation, and the pursuit of broad societal goals. At the same time, it puts forward suggestions for follow-up research.@en

On 10 October 2012, the United States Anti-Doping Agency published an investigative report on the use of performance-enhancing drugs by professional cyclist Lance Armstrong. The report paints a disconcerting picture of the doping program that Armstrong and his US Postal Service professional cycling team managed to carry out for several years, despite being subject to many inspections. It contains a wealth of unique empirical data, including a large number of affidavits. In this article, we use this data to answer the question of how Armstrong was able to prolong prohibited behavior. In doing so, we focus in particular on the interactions between Armstrong and the many doping inspectors he encountered. Our analysis results in a variety of answers to this question. First, inspectors were confronted with an inspectee who behaved as an “amoral calculator” and acted strategically. The strategies of inspectors were not adequately attuned to such behavior. Second, the team's internal professional control was neutralized by various factors, including its strict hierarchy and the many friendships within the team. And, finally, the environment created strong incentives to start doping and subsequently deny doing so. We argue that the dynamics underlying doping necessitate a combination of measures to regulate the use of performance-enhancing drugs in the field of professional cycling and beyond.@en

As part of a major health care reform starting in 2005, the Netherlands introduced a Diagnosis-Related Group (DRG) system of hospital care reimbursement and performance measurement. The DRG system was applied to all hospital care, meaning that it affected the overwhelming majority of Dutch specialist medical professionals. To better understand the consequences of this new system, and the responses of medical professionals to its implementation, we conducted and analysed an original set of sixty-six semi-structured interviews focused on medical specialists’ perception and utilization of the system. Our findings indicate that these professionals’ behaviours can seldom be ascribed to financial motives alone. Many responses of medical professionals to the new system were attributed to value-based motivations, related to upholding professional ethos and accommodating the dynamics of the professional process. Even responses that might be characterized at first as financially driven could not be entirely understood as perverse effects of the performance management system, as they too usually had an ancillary aim of safeguarding the professional tenets of the medical establishment.@en