Two types of legalization can be distinguished. In type 1 legal relations between parties are changed, without consequences for others. In legalization type 2 a change in legal positions does have consequences for third parties. The gradual change in the legal position of patients, managerial measures and the transition to ‘demand driven care’ have changed the relations between patients and doctors, nurses etc. But they had also profound external effects. They have influenced especially other interests than the quality of medical care, like equal treatment of patients and professional discretion. Decision making about the granting of rights should incorporate these external effects.