On the borders of the civil society? Private health insurance and civil society in the Netherlands 1900-2006

1
On the borders of the civil society? Private
health insurance and civil society in the
Netherlands 1900-2006
KHZ, dept. Medical Humanities

• R.A.A. Vonk
• Posthumus conference 2010
• 21 May 2010, Leiden University

2

• To what extent did the interaction of public and
  private interests shape the private health
  insurance industry in the Netherlands during the
  period 1900-2006?

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Private health insurancea non-governmental,
indemnity based insurance plan, whose scope is
not limited by an income-threshold, that provides
coverage for medical expenses due to illness or
disability.
KHZ, dept. Medical Humanities
4
Classic view
KHZ, dept. Medical Humanities

• Sickness fund as carriers of social health
  insurance (even before its official institution
  in 1941)
• Emphasis on inclusion (people, benefits, etc.)
• Abhorrence of profit-making
• Emphasis on solidarity
• Champions of the common good
• Private health insurance industry more concerned
  with making profit than with providing access to
  health care
• Emphasis on exclusion (benefits, people, etc.)
• Lust for profit and profit-maximization
• Emphasis on individualism
• Champions of free-marketeering

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Oddities
KHZ, dept. Medical Humanities

• only minimal profits
• inclusion of benefits and non-profitable
  high-risk groups (i.e. risk-pooling)
• emphasis on cooperation with government, medical
  professionals, sickness funds and other
  stakeholders

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Civil Society classic view
state
market
self-organization
justice
democracy
Civil society voluntary association
diversity
common good
plurality
individual
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Health insurance and civil society in the 20th
century
state
market
Civil society
individual
8
Health insurance and civil society in the 20th
century

• CS incorporates mutual health insurance schemes
• As a sphere of emphasis on values of civility and
  public interests
• CS does not incorporate
• statutory health insurance (state)
• commercial/corporate health insurance (market)
• bovenbouw insurance
• blending of commercial and civil ideas and values
  in PHI
• hybrid organizations

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Market share of health insurance carriers in
percentages, 1950-1986
Type / Year 1950 1955 1959 1960 1965 1970 1975 1980 1985 1986
Commercial 57 43 35 42 40 36 36 33 29 25
Mutual 35 29 25 26 25 25 25 27 33 32
Bovenbouw 8 28 40 32 35 39 39 40 38 43
Total 100 100 100 100 100 100 100 100 100 100
Source F.T. Schut, Competition in the Dutch
health care sector (1995) 139.
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The dissolution of civil society and the blending
of civicness
state
market
third sector service providers
corporate social responsibility
community services
Civil society voluntary association
citizen initiatives
consumer activism
informal groups
Individual
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The dissolution of civil society and the blending
of civicness
state
market

• ENZICO

• Zilveren Kruis

• GAF

• VZVZ

• OHRA

• VGNN

• Sickness funds

• VGCN

• ONVZ

• de Goudse

• FBTO

• Haarlem

Civil society

• VGZ

• De Verpleging

• Nationale Nederlanden

- Bovenbouw
- Commercial
- Mutual
- Municipal
- Soc. HI
Individual
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- takes into account the role of civil society,
but has an emphasis on the borders between cs and
the state, market and private sphere- allows
for interaction and cross-fertilization of ideas
and values between civil society other social
spheres- framework to portray interaction
between public and private interests- did civil
society create a more civil PHI-industry?
The dissolution of civil society and the blending
of civicness
Benefits of dissolution-approach