Individual Responsibility and Solidarity in European Health Care: Further Down the Road to Two-Tier System of Health Care

Abstract

European health care systems are in process of profound reconstruction. In many countries, one can notice various attempts to reduce the package of public services and to increase the private contributions of beneficiaries. This development is often considered as retreat of the concept of solidarity, which meant both a benevolent attitude toward weaker groups in society and a commitment to fair or even egalitarian distribution of health care services (Houtepen and ter Meulen, 2000). The concept of solidarity provided for a long time the ideological rationale for the transfer of financial contributions by individuals by way of compulsory health insurance schemes or national taxation to a universal health care system that should guarantee equal access to health care for those who are in need. The concept of solidarity was rooted firmly in European culture reflecting a mixture of various philosophical, religious, and cultural traditions, particularly Christian social ethics and social democratic ideology. It meant a strong responsibility of society for the needs of the individual in relation to health and welfare.