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Author Notes:

Correspondence: rsaltma@emory.edu

The initial thinking for this paper was presented as a commentary at a conference held to mark the 50th anniversary of the Belgian statutory health insurance act in Brussels on 21 March 2014.

The author thanks the journal’s three anonymous reviewers as well as David Chinitz for their very helpful suggestions, also Ann-Kathryn Seeman and Carly Rae Winokur for comments on prior versions of this paper.

The author warrants that there are no competing interests or conflicts of interest regarding the content of this article.



  • Science & Technology
  • Life Sciences & Biomedicine
  • Health Policy & Services
  • Public, Environmental & Occupational Health
  • Health Care Sciences & Services
  • Solidarity
  • Social health insurance
  • European values
  • Austerity

Health sector solidarity: a core European value but with broadly varying content


Journal Title:

Israel Journal of Health Policy Research


Volume 4


Type of Work:

Article | Final Publisher PDF


Although the concept of solidarity sits at the center of many European health sector debates, the specific groups eligible for coverage, the financing arrangements, and the range of services and benefits that, together, compose the operational content of solidarity have all changed considerably over time. In prior economic periods, solidarity covered considerably fewer services or groups of the population than it does today. As economic and political circumstances changed, the content of solidarity changed with them. Recent examples of these shifts are illustrated through a discussion of health reforms in Netherlands, Germany and also Israel (although not in Europe, the Israeli health system is similar in structure to European social health insurance systems). This article suggests that changed economic circumstances in Europe since the onset of the 2008 financial crisis may lead to re-configuring the scope and content of services covered by solidarity in many European health systems. A key issue for policymakers will be protecting vulnerable populations as this re-design occurs.

Copyright information:

© Saltman; licensee BioMed Central.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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