The Impact of Reforms of National Health Insurance on Solidarity in the Netherlands: Comparing Health Care Insurance and Long-Term Care Insurance

Maartje van der Aa, Agnes Paulus, Saskia Klosse, Silvia Evers, Hans Maarse*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Context: Throughout Europe, the financial risks of health and long-term care are covered to varying degrees through models of national (health) insurance. Such insurance draws upon the principle of solidarity. Much is unknown on the solidarity-effects of reforms in national insurance schemes.
Objective: To present an empirical analysis of the effects of recent reforms in national health insurance on solidarity in one country. Methods: We conducted a comparative analysis of the 2006 health care insurance reform and the 2015 long-term care insurance reform in the Netherlands. A multidimensional analytical framework of solidarity was developed to study the solidarity-effects of both reforms. Findings: Reforms of health care and long-term care insurance in the Netherlands had some solidarity effects, but they should not be overstated. We found evidence for increased and decreased solidarity. Health care insurance seems more ‘immune’ to reductions in solidarity than long-term care insurance.
Limitations: The present case study involves reforms in the Netherlands. The solidarity framework is specifically designed for the study of solidarity-effects of reforms on national health and long-term care insurance. Effects on informal arrangements for care are beyond the scope of this study. More detailed and quantitative research is required to investigate how the reforms played out for specific groups, for instance the frail elderly, people with a disability and people with rare conditions. Similarly, long-term effects require further investigation. Implications: Given the limited scope of our analysis, more comparative research (including on an international scale) is required to develop systematic insight into the solidarity-effects of reforms in national health and long-term care insurance.
Original languageEnglish
Pages (from-to)143-152
JournalJournal of Long-Term Care
Publication statusPublished - 4 Nov 2019


  • Solidarity
  • health care insurance
  • long-term care insurance
  • Netherlands

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