Two Centuries of Solidarity

Today, health insurance is a key component in the system of social security in most European Union countries. In many of these countries, modern health-insurance funds and healthcare insurers play an essential role in implementing the public health-insurance system. Many of these health-insurance funds have a long and fascinating history, of which clear traces can be seen today in the organisation and structure of health insurance, as well as health-insurance funds and insurers. In Two centuries of solidarity, the authors compare the systems of health insurance, health-insurance funds and healthcare insurers in Germany, Belgium and the Netherlands. Given the similar political, economic and social development that these countries have undergone in the past 60 years and the availability of a qualitatively high level of health care, one might expect a high degree of similarity between these countries' healthcare insurance systems. However, the dissimilarities are surprising. In fact, these differences are currently becoming ever more apparent between systems in general, and the structure and operation of the health insurance funds and health care insurers in particular. The differences include the compulsory nature of insurance, the extent of coverage, premiums, entrepreneurship, competition, and the degree of private insurance. Many of these national singularities can be understood and explained only by considering the historical background of the health insurance systems, the insurers, and their evolution over the past two centuries. This study adopts an institutional and political perspective towards a further understanding of the development of health insurance, and of how this ultimately determined the specific nature of the healthcare insurers and funds and the way they currently operate in Germany, Belgium and the Netherlands

Family size and intergenerational social mobility during the fertility transition: evidence of resource dilution from the city of Antwerp in nineteenth century Belgium

It has been argued in sociology, economics, and evolutionary anthropology that family size limitation enhances the intergenerational upward mobility chances in modernized societies. If parents have a large flock, family resources get diluted and intergenerational mobility is bound to head downwards. Yet, the empirical record supporting this resource dilution hypothesis is limited. This article investigates the empirical association between family size limitation and intergenerational mobility in an urban, late nineteenth century population in Western Europe. It uses life course data from the Belgian city of Antwerp between 1846 and 1920. Findings are consistent with the resource dilution hypothesis: after controlling for confounding factors, people with many children were more likely to end up in the lower classes. Yet, family size limitation was effective as a defensive rather than an offensive strategy: it prevented the next generation from going down rather than helping them to climb up the social ladder. Also, family size appears to have been particularly relevant for the middle classes. Implications for demographic transition theory are discussed