Two centuries of solidarity

German, Belgian and Dutch social health insurance 1770-2008.

Health insurance is a key component of the current social security system in European Union countries. In most countries, modern health insurance funds and health care insurers are an essential role in implementing the public health insurance system. Many of these modern health insurance funds have a fascinating and long ancestry, clear traces of which can be seen today in the organisation of national health insurance, as well as the structure of health insurance funds and insurers.

In their study Two Centuries of Solidarity, the authors compare health insurance, health insurance funds and health care insurers in Germany, Belgium and the Netherlands. Given the similar political, economic and social development that these countries have undergone in the past 60 years and the qualitatively high level of health care they provide, one might expect a degree of likeness in these countries’ health care insurance systems. The dissimilarities are surprising, however. In fact, differences are becoming ever more apparent between the different national systems in general, and between the structure and operation of the health insurance funds and health care insurers in particular. Differences include the compulsory nature of insurance, the extent of cover, premiums, health insurance business, mutual competition, and the degree of private insurance.

Many of these national singularities can be understood and explained only by considering the historical background of the current national health insurance systems, the insurers, and their evolution over de past centuries. This study adopts an institutional and political perspective towards further understanding of the development of health insurance, and of how this ultimately determined the specific nature of the health care insurers and funds, and how they currently operate in the three countries studied.