PhD conferral Ms Maartje J. van der Aa, MSc.

Keywords: cost of care, healthcare, incapacity for work, social insurance, solidarity, reform, opinions

"Financial risks of illness: a shared responsibility? Solidarity and deservingness in health insurance and disability insurance in the Netherlands"

Being ill costs money, but who is responsible for paying for it? For centuries, healthcare costs and health-related benefits have been funded by all residents. Since the nineteenth century, this has been arranged formally in social insurance schemes, which have been strongly reformed in the Netherlands since the 1980s. This dissertation found that such reforms have had different effects on solidarity. Where solidarity is limited on specific points in insurance policies that cover health-related loss of income and long-term care, in other cases curative care has been maintained or even expanded.

With regard to the opinions about distributing collective funds from these disease-related social insurances, it appears that a more conditional approach was taken toward benefits for illnesses than for a reimbursement of healthcare costs. This again points to the special status of social health insurance programmes compared to insurance for illness-related loss of income. It was also found that opinions differ with respect to granting or not allocating funds from social insurance schemes. With respect to policy practice, we should not view general public opinion as 'the opinion' of 'the average Dutch person'.