Solidarity and Care in the Netherlands
In his chapter on solidarity, based on the theories of classical and modern sociologists, Van Oorschot (1998) defines solidarity as ‘an actual state of interrelations between individuals, groups and the larger society, which enables the collective interest to take priority over the interests of individuals or sub-collectivities’. In doing so, he seems to rephrase Durkheim’s organic solidarity. The Dutch health care system may cause one to wonder if such a definition enables us to grasp what solidarity really means. In our view, it makes the existing solidarity arrangements only partly visible. It takes solidarity on the macro-level into account, but not solidarity on the micro level, with regard to the delivery of informal care.
Limiting solidarity in the Netherlands: a two-tier system on the way.
: Health care policy in the Netherlands has long been guided by the values of solidarity and equality. As a result of several forces, particularly the scarcity of resources, the retreat of the Welfare State and the introduction of market forces in health care, both values are increasingly under strain. Next to solidarity and equality, freedom of choice and financial responsibility are playing an important role in Dutch health care. Consequently, there is a growing division in Dutch health care between two tiers, one basic tier giving access to a basic package of services and a luxury tier giving access to a higher quality of care and to services not included in the basic package. The main thesis of the article is that a two-tier system is morally justified on the condition that the basic tier is universally accessible and is based on the value of humanitarian solidarity.
Cost containment and new priorities in the European community.
This article reports on the author's survey of the cost-control measures for health care in 12 European countries during the period from 1983 to 1990. Among these countries the greatest convergence was in the use of the budget as a system of control, reinforced by manpower controls. Budgets were constructed to restrict hospital costs and payments to doctors practicing outside of hospitals. Another strategy was cost sharing for purchase of drugs and, in some cases, for dentistry. Most countries took steps to control expensive medical equipment; others, to restrict entry to medical schools. The European experience demonstrates the technical feasibility of the government's controlling health care costs by regulating supply rather than demand. The key to Europe's success in the use of monopsony power, whereby one purchaser dominates the market. The author contends that regulation works in Europe and questions whether the United States can exert similar control over its coalition of insurers and providers in order to rein in its health care expenses.