HPI4009 Health Systems Governance case 5

Health system governance (HPI 4009)

Tutorial group 5 13-12-2019
Case 5: Solidarity in healthcare financing

Solidarity and forms of solidarity
Solidarity: that which binds individuals into a relatively autonomous society, or negatively stated, that
which prevents the disintegration of a society.
Solidarity: the willingness to protect those human persons whose existence is threatened by
circumstances beyond their control, particularly natural fate or unfair social structures.

Forms of solidarity
Basis viewpoint Shared utility Shared identity
homo ecologicus homo sociologicus
‘we need each other’ ‘we are one’
 Rational  Subjective
 Emotional
 Traditional
E.g.: hospitality (they do solidarity, E.g.: NGO, help each other, live in same
but they depend on each other) and building where you all want a nice garden.
church.
Durkheim Organic (structural) Mechanic (cultural)
- Macro level  Division of labour   Culture
people are dependent on  Society
each other  Harmony
 Specialization  Voluntariness
 People are motivated by  People share same cultural
interests elements
Weber Associative relationship Communal relationship
- Micro level ‘Vergesellschaftung’ ‘Vergemeinschaftung’
Can involve conflict and coercion. E.g.: religious brotherhood, erotic
relationship.
- Meso level Hechter Parson Mayhew
- Organisationa  Individuals rely on each other Institutions Relations formed 
l level to satisfy their needs. needed; network  main goal 
 Groups can only function if moral shared identity and
their member contribute. obligation. collective interests
 3 reasons why people do Collective
something: interests take
- Moral convictions (beliefs, priority over
own judgement) individual
- Moral obligation interests.
(judgement society)
- Fear of sanctions (fine)
Free riders: with Common good!
E.g.: highway, education.


Conclusion
 Solidarity as a state of relations between individuals and groups enabling collective interests to
be served.
 Essence / basis for relations: people have or experience a common fate, either because they share
identity as member for the same community and therefore feel a mutual sense of belonging and
responsibility, or because they share utility: they need each other to realise their life
opportunities

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, Homo sociologicus:

o Humans as essentially social beings
o Act according to their affections for others
o Internalised cultural norms and values
 Homo economicus:
o Non-social beings
o Self-interest
o Maximise personal utility in their relation with others
o Only contribute to the common good if it is sufficiently profitable
NOT perceive solidarity as a sentiment of people (all discriptional)

Difference between justice and solidarity
Solidary: ‘warm solidary’. More to do with moral. Is a choice.
Justice: ‘cold solidarity’. More to do with rights (fairness), it has to be there. The more justice, the
less solidarity. NL: more to justice.

The 2 principles of justice according to Rawls:
1. You can do everything what you like, but it should not affect others. Example: you can do all
the shopping you would like, but if you buy something that is produced with child-labour, it
affects others. Health: basic care package.
2. If we were to accept inequalities, everybody should get the opportunity to get higher in
society. Health: private insurance should be attainable for everybody.
Daniels argues that society has the obligation to provide a minimum of health care, which should
assure that every individual has access to a tier of services that promotes normal functioning and thus
protects fair equality of opportunity.

Problems with solidarity
 The health care systems may not be able to meet the responsibilities associated with solidarity, due
to increasing demands for expensive treatments, the ageing of the population and more demanding
attituded of patients and clients.  The governments is putting more emphasis on individual
financial responsibility as well as personal responsibility for one’s own health by healthy
lifestyles.
 The lack of a clear definitions of the concept; what responsibilities doe we owe to each other and
what are the boundaries of responsibility.

Motives for solidarity and non-solidarity (i.e. actuarial fairness)
Actuarial fairness
 Non-solidarity: you pay a premium according to your risk. So, people with a higher risk
profile pay more. It would be unjust to force a group or person to pay for the needs/burdens of
others. It is unfair, because it reduces access to life opportunities and increases suffering for
those disadvantaged by risk, pain, and illness.
 Healthcare: health is commodity  private health insurance.

Motives to support solidarity
1. Mutual affection and identification (Mayhew’s view, shared identity)
The degree to which people feel attracted to one another and are loyal at the micro level, and
the degree to which they perceive a collective identity and we-feeling at the meso and macro
level are decisive for the solidarity between them.

2. Moral convictions (Durkheim and Parsons view)
Culturally-based convictions, which imply that the individual feels a moral obligation to serve
the collective interest and to accept existing relations of solidarity.

3. Perceived self-interest (Hechter’s view, and Dukrheim’s, shared utility)

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