TWO CENTURIES OF SOLIDARITY

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1 TWO CENTURIES OF SOLIDARITY German, Belgian and Dutch social health insurance K.P. COMPANJE, R.H.M. HENDRIKS K.F.E. VERAGHTERT AND B.E.M. WIDDERSHOVEN a

2 TWO CENTURIES OF SOLIDARITY

3 HiZ-series History of Healthcare Insurance 1. Brigitte Widdershoven, Het dilemma van solidariteit. De Nederlandse onderlinge ziekenfondsen, (Aksant: Amsterdam, 2005) isbn K.P. Companje (ed.), Tussen volksverzekering en vrije markt. Verzekering van zorg op het snijvlak van sociale verzekering en gezondheidszorg (Aksant: Amsterdam, 2008) isbn K.P. Companje, R.H.M. Hendriks, K.F.E. Veraghtert and B.E.M. Widdershoven, Two centuries of solidarity. German, Belgian and Dutch social health insurance (Aksant: Amsterdam, 2009) isbn

4 Two centuries of solidarity German, Belgian and Dutch social health care insurance K.P. Companje, R.H.M. Hendriks, K.F.E. Veraghtert and B.E.M. Widdershoven a Amsterdam 2009

5 This publication has been made possible with financial support from the Kattendijke/Drucker Foundation and the Unger-Van Brerofonds. isbn Copyright 2009 the authors and Aksant Academic Publishers, Amsterdam. All rights reserved, including those of translation into foreign languages. No part of this publication may be reproduced in any form, by photoprint, microfilm or any other means, nor transmitted into a machine language without written permission from the publisher. Translation: Textware, Utrecht/Yvette Mead and Nancy Forest-Flier Translation copyright: Yvette Mead and Nancy Forest-Flier Cover design: Jos Hendrix, Groningen Photo cover: AMSAB, Ghent (Belgium) Lay-out: Bert Heesen Produkties, Utrecht Printed in the Netherlands. Aksant Academic Publishers, PO Box 2169, 1000 CD Amsterdam, The Netherlands,

6 PREFACE This volume, Two centuries of solidarity. German, Belgian and Dutch social health insurance , is an updated and translated edition of Twee eeuwen solidariteit. De Nederlandse, Belgische en Duitse ziekenfondsen tijdens de negentiende en twintigste eeuw, published in 2001 by the Stichting Historie Ziekenfondswezen (Stichting HiZ; Foundation for the History of Health Insurance) in close cooperation with Aksant Academic Publishers. In most EU-countries the system of structuring and financing healthcare is in a constant state of change. The division of roles between state, health insurers, care providers and consumers is changing. The introduction of regulated competition, the re-regulation of supervision and prices and an orientation towards consumer-driven healthcare, cost containment and sustainability are key-concepts in the political restructuring-effort of healthcare and social security. How these adaptations will develop in the upcoming decennia is uncertain. They not only depend on national political and social relations, but also on the influence of supranational legislation by the European Union. How health insurance will function in 2020 is unforeseeable. At present, Europe has no direct jurisdiction on the national systems of healthcare and social security of its 25 member states. The principle of subsidiarity, laid down in the Treaty of Rome (1957) and reconfirmed in the Treaty of Amsterdam (1999), stipulates that health insurance and the structure of healthcare are a matter of the individual member states. The core of the European Union, though, is its free internal market. The influence of the EU on national systems of healthcare and social security is therefore indirect, but unmistakably present. Prime examples of this influence are the rulings of the European Court of Justice in the renowned Decker/Kohl-arrests, enabling the provision of transnational healthcare. The European Parliament wishes to strengthen this development. The frontiers between national systems of healthcare and health insurance will probably fade in the future. This brings the risk that knowledge of these national systems and the lessons that can be drawn from them will be lost. Bearing this in mind the Stichting HiZ and the Kenniscentrum Historie Zorgverzekeraars (Centre for the History of Health Insurance) wanted to publish a comparative historical study to document and analyse the characteristics and strengths and weaknesses of the system of health insurance in the Netherlands and other EU-countries. Describing and interpreting the historical development of the

7 ii TWO CENTURIES OF SOLIDARITY health insurance systems of all EU-countries would probably take a lifetime. The authors therefore restricted themselves to three countries: Germany, Belgium and the Netherlands; three neighbouring countries with their own long history of insuring the risks of sickness, disability and accidents. The Board of the Stichting HiZ asked the authors K.P. Companje, K.F.E. Veraghtert, B.E.M. Widdershoven and R.H.M Hendriks to edit and translate the Dutch edition of Twee eeuwen solidariteit, which was published in Much has changed in the German, Belgian and Dutch systems of healthcare and health insurance since Two centuries of solidarity is not only the English translation of Twee eeuwen solidariteit, it also describes and clarifies developments in the system of health insurance and social security of these countries from 2000 onwards. How did the government and civil society, as joint partners in healthcare and health insurance, collaborate to remould the principles of solidarity, coverage of risks and sustainability as future cornerstones of the subsequent systems? And what was the influence of the European Union on these developments? The authors and the Stichting HiZ do not pretend to provide lessons for the future of healthcare and health insurance. They do hope to give the reader insight in the long history of this special branch of the large tree of social security, which eventually guaranteed every citizen of the Netherlands, Belgium and Germany of full coverage against the costs of medical care. The slow process of political and social implementation of basic social values, such as solidarity and cooperation, and underlying ideological notions about society and healthcare, provides us with a fascinating and rich history. The Board of the Stichting HiZ wants to thank the authors who succeeded in writing this scientific, yet accessible study, and Aksant Academic Publishers for its publication. The Stichting HiZ also wants to express their gratitude to the parties which supported this project: the Belgian National Alliance of Christian Mutualities and the National Alliance of Social Democratic Mutualities. A comprehensive European approach of social security and healthcare policy is something for the future. We hope that the history of the national systems of healthcare and social security will be its organic foundation. Only in this way the anti-european sentiments of past years can be turned from developing for the worse. December 2009 E. Boer, W. Annard, Chairman secretary

8 CONTENTS Preface i Contents 1 Acronyms and abbreviations 7 Translations 11 Introduction 21 Chapter I. Guilds and sickness funds. Solidarity during the Ancien Régime The development of national health insurance in the Netherlands Sickness funds in the cities of Flanders The German example: the Knappschaftskassen 35 Summary 36 Notes 36 Chapter II. The end of the guild system, The shock of the French revolution The Le Chapelier Law: the final blow for the guilds in the Southern 40 Netherlands 3. The desperate struggle of the Dutch guilds The German guilds: between stone-dead and alive-and-kicking 43 Summary 43 Notes 44 Chapter III. The birth of modern social health insurance The guilds are dead. Long live the mutual societies 45 a. Ghent sets the trend 45 b. The other Flemish cities: a slow beginning 49 Summary The Netherlands: a colourful patchwork of funds 51 a. Occupation-related and general mutual societies: a difficult existence 51 b. Nutsfondsen and commercial funds: plugging the largest gaps 53 c. Doctors funds and company funds: a tentative beginning 55

9 2 TWO CENTURIES OF SOLIDARITY Summary The German funds: tradition and renewal 57 a. Health insurance: a local concern 57 b. Bavaria and Prussia: a shift in the approach of national government 58 Summary 61 Notes 62 Chapter IV. Health insurance as a governmental responsibility, Germany: the government under obligation 63 a. The Prussians take charge 63 b. Unity and centralisation: Bismarck steps in 65 c. The law of 1883: the introduction of compulsory health insurance 67 d. Peaceful growth, e. The socialists and health insurance 71 f. Health-insurance funds versus doctors 75 Summary Belgium: government support 79 a. The first Mutualistische Wet, b. Socialists, Catholics and neutrals 82 c. Following the German model, d. The Mutualiteitwet of 1894: subsidised freedom 88 e. Growth and concentration 90 f. The First World War throws a spanner in the works 94 Summary The Netherlands: the government looks on 97 a. Dutch society on the move 97 b. A motley collection of funds, c. The long legislative path 104 d. Passed and yet back to square one 109 e. Power struggle 114 Summary 120 Notes 122 Chapter V. War, peace, war, Germany from crisis to crisis 125 a. War 125 b. The Weimar Republic, c. The Nazi regime, Summary Belgium: voluntary healthcare insurance stands firm 141 a. The misery of war 141

10 CONTENTS 3 b. Reconstruction 142 c. From depression to war 154 Summary The Netherlands: drawn-out indecisiveness and sudden breakthrough 156 a. War on the border 156 b. Many words, few deeds: the failure of the legislature 157 c. The Dutch health insurance fund system: growth, struggle and immobility 170 d. The Second World War: an unexpected breakthrough The end of the war: forward or back? 189 Summary 189 Notes 191 Chapter VI. Growth and its limits, Germany 195 a. Peace and reconstruction 195 b. Health-insurance funds back in their old form, c. A two-tier insurance system 198 d. Doctors and health-insurance funds: sometimes united, sometimes divided 208 e. The government steps in 210 f. Structural intervention: the legislation of 1989, 1992 and Summary Belgium 219 a. Rapid economic recovery 219 b. A modern social security system 220 c. At last compulsory insurance for sickness and disability 221 d. Deficits and shortfalls 225 e. Political battles, f. The Wet-Leburton (9 August 1963): a milestone 231 g. Laws and practical difficulties interfere between word and deed, h. From mutuality to health-insurance fund: the Act of 6 August i. The health-insurance fund landscape 241 j. Developments Summary The Netherlands 248 a. New social initiatives 248 b. Slow legislation, c. The world of the health-insurance funds, d. Three decades of tinkering, e. The world of health insurance, Summary 281 Notes 282

11 4 TWO CENTURIES OF SOLIDARITY Chapter VII. Social health insurance and neoliberal regulated market 287 competition, The insurance of care in Germany, a. Modernisation of the Pfl egeversicherung 287 b. Limited modernisation of the Gesetzliche Unfallversicherung 292 c. Cost increases and solidarity, or: the need to reform Gesetzliche and Private 295 Krankenversicherung d. The reform of GKV and PKV: political and social consensus 297 e. Management systems, care and financial restructuring 299 Summary Recent developments in the Belgian medical insurance system 310 a. The Belgian medical insurance system 310 b. Persistent budgetary problems 310 c. Dark future 311 d. No structural reforms 312 e. Timid attempts at adaptation 312 f. The patient left holding the baby 315 g. Room for supplementary insurance 318 h. Competition between the health-insurance funds 321 i. Medical insurance in the north-south discussions Changes in the Dutch system of healthcare insurance, a. The political and social context 326 b. The influence of the European Union 329 c. Influence of developments in healthcare 331 d. The discussion on the revision of the healthcare system and healthcare 333 insurance e. The reform of healthcare insurance by legal measures and the consequences 335 in practice f. The effects of the new legislation in practice 337 g. Possible impact of collective contracts on the flat-rate contribution 339 h. A glimpse at the future 340 Notes 342 Chapter VIII. The art of mutual understanding: one concept in three 349 countries 1. Similar countries different solutions Striking differences 351 a. Compulsory healthcare insurance 351 b. Risk coverage 352 c. Premiums and contributions 356 d. Generous and frugal governments 358

12 CONTENTS 5 e. The income limit 359 f. The world of the health-insurance funds 360 g. Cooperation and competition 362 h. Managing the health-insurance funds 365 i. Separate facilities and staff 367 Conclusion 370 Notes 374 Tables and charts 375 Bibliography 377

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14 ACRONYMS AND ABBREVIATIONS ABVV ABGV ACLVB ACV ACW AIM AMSAB ANOZ ANWV AOW AOZ ARP ASGB AVB AVGV AWBZ AZA AZIVO BKK BRD BWP CAVINED CBOZ CBS CBZ CDA CDU CHU CNV COZ Algemeen Belgisch Vakverbond Algemeen Belgisch Geneesherenverbond Algemene Centrale van Liberale Vakbonden van België Algemeen Christelijk Vakverbond Algemeen Christelijk Werknemersverbond Association Internationale de la Mutualité Archief en Museum van de Socialistische Arbeidersbeweging Algemeen Nederlands Onderling Ziekenfonds Algemeen Nederlandsch Werklieden-Verbond Algemene Ouderdomswet Amsterdams Onderling Ziekenfonds Antirevolutionaire Partij Algemeen Syndicaat van Geneesheren van België Allgemeine Versicherungsbedingungen Algemeen Vlaams Geneesherenverbond Algemene Wet Bijzondere Ziektekosten Algemeen Ziekenfonds voor Amsterdam Algemeen Ziekenfonds De Volharding (Den Haag) Betriebskrankenkasse Bondsrepubliek Duitsland Belgische Werkliedenpartij Centrale Administratie Verzekeringsinstellingen in Nederland Centrale Bond van Onderling Beheerde Ziekenfondsen Centraal Bureau voor de Statistiek Centrale Bond van Ziekenfondsen Christen-Democratisch Appel Christlich-Demokratische Union Christelijk Historische Unie Christelijk Nationaal Vakverbond Centraal Overleg van Ziekenfondsorganisaties

15 8 CSO CSU CVP DMP EGKS FDP FNV Federatie VMZ FVMZ G-BA GKAR GKK GKV GOZ GSV GPV HiZ HRA IISG IZA IZR KAB KADOC KBV KHZ KLOZ (K)NMG (K)NMP KVAndG KVD KVKG LBBOZ LCM LFBZ LISZ LKK LLM LNM TWO AGES SOLIDARITY Centrale Samenwerkende Ouderenorganisaties Christlich-Soziale Union Christelijke Volkspartij Disease Management Programme Europese Gemeenschap voor Kolen en Staal Freie Demokratische Partei Federatie Nederlandse Vakbeweging Federatie van Vereenigde Maatschappij Fondsen, (na 1952 Federatie van door Verzekerden en Medewerkers bestuurde Ziekenfondsen) Gemeinsamen Bundesausschuss Gesetz über Kassenartzrecht Gesetzliche Krankenkasse Gesetzliche Krankenversicherung Gemeenschappelijk Overleg van Ziekenfondsorganisaties Geschäftsgruppe Soziale Verwaltung Gemeenschappelijke Politie Verzekering Stichting Historie Ziekenfondswezen Hoge Raad van Arbeid Internationaal Instituut voor Sociale Geschiedenis Instituut Zorgverzekering voor Ambtenaren (ziekteverzekering gemeentepersoneel) Instituut Zorgverzekering (ziekteverzekering provinciepersoneel) Katholieke Arbeidersbeweging Katholiek Documentatiecentrum (K.U.Leuven) Kassenärztliche Bundesvereinigung Centre for the History of Health Insurance Kontaktorgaan (voor 1980 Kommissie) Landelijke Organisatie van Ziektekostenverzekeraars (Koninklijke) Nederlandse Maatschappij ter Bevordering der Geneeskunst (Koninklijke) Nederlandse Maatschappij ter Bevordering der Pharmacie Krankenversicherung-änderungsgesetz Kassenärztliche Vereinigung Deutschlands Krankenversicherungs-Kostendampfungsgesetz Landsbond van Bedrijfs- en Onzijdige Ziekenfondsen Landsbond van Christelijke Mutualiteiten Landelijke Federatie ter Behartiging van het Ziekenfondswezen Landelijk Informatiesysteem Ziekenfondsen Landkrankenkasse Landsbond Liberale Mutualiteiten Landsbond Neutrale Mutualiteiten

16 ACRONYMS AND ABBREVIATIONS 9 NAF NEHA NHVC NMa NMBS NMT NOZ NSB NSDÄB NVSM NVV NVVZA NZa OKK PSC PvdA PKV RAM RIZIV RKWV RMZ RSA RVO SAZ SDAP SDB SER SOAZ SPD VAV VDGU VMZ VNW VNZ VVD VVGB VWS VZW WAZ WIGW WMO Nederlands Arbeidsfront Nederlandsch Economisch-Historische Archief Nationaal Hulp- en Voedingscomité Nederlandse Mededingingsautoriteit Nationale Maatschappij van Belgische Spoorwegen Nederlandse Maatschappij ter Bevordering van de Tandheelkunde Nederlands Onderling Herverzekeringsinstituut voor Ziektekosten Nationaal-Socialistische Beweging Nationalsozialistische Deutsche Ärztebund Nationaal Verbond Socialistische Mutualiteiten Nederlands Verbond van Vakverenigingen Nederlandse Vereniging van Ziekenfondsartsen Nederlandse Zorgautoriteit Ortskrankenkasse Parti Social Chrétien Partij van de Arbeid Private Krankenversicherung Reichsarbeitsminister Rijksinstituut voor Ziekte- en Invaliditeitsverzekering Rooms-Katholiek Werklieden Verbond Rijksdienst voor Maatschappelijke Zekerheid Risikostrukturausgleich Reichsversicherungsordnung Stichting Autonome Ziekenfondsen Sociaal-Democratische Arbeiders Partij Sociaal-Democratische Bond Sociaal Economische Raad Stichting Organisatie en Automatisering Ziekenfondsen Socialistische Partei Deutschlands Vrije aanvullende verzekering Verband Deutsche Gesetzliche Unfallversicherung Vereenigde Maatschappij Ziekenfondsen Vereniging Nederlandse Werkgevers Vereniging van Nederlandse Ziekenfondsen Volkspartij voor Vrijheid en Democratie Vereniging der Vlaamse Geneesheren van België Ministerie van Volksgezondheid, Welzijn en Sport (Nederland) Vereniging zonder winstgevend doel Werken aan Zorgvernieuwing Weduwen, Invaliden, Gepensioneerden en Wezen Wet Maatschappelijke Ondersteuning

17 10 WTZ ZIV ZN ZVA ZZ TWO AGES SOLIDARITY Wet op de Toegang tot de Ziektekostenverzekering Ziekte- en Invaliditeitsverzekering Zorgverzekeraars Nederland Ziektekostenverzekeringen speciaal voor Ambtenaren en Leraren (Ziekteverzekering Staatsambtenaren) Ziekenzorg

18 TRANSLATIONS Algemeen Afdelingsfonds aaz-fonds - sickness fund of the Dutch Medical Association Algemeen Belgische Geneesherenverbond ABVG - General Association of Physicians (Belgian) Algemeen Christelijk Werkgeversverbond ACW - General Christian Employers Alliance (Belgian) Algemeen Nederlands Onderling Ziekenfonds ANOZ - General Netherlands Mutual Health-insurance fund (Dutch) Algemeen Nederlandsch Werklieden Verbond ANWV - General Dutch Workers Alliance Algemeen Syndicaat der Geneesheren van België - General Medical Union of Belgium Algemeen Vlaamse Geneesherenverbond AVGV - Flemish Physicians Union (Belgian) Algemeen Ziekenfonds te Amsterdam AZA- General Sickness Fund Amsterdam (Dutch) Algemeene Raad ter bevordering van het Ziekenfondswezen, Algemeene Raad - General Council for the Advancement of the Health-insurance fund System (Dutch) Algemene Ouderdomswet AOW - General Old-Age Pensions Act (Dutch) Algemene Rekenkamer - Netherlands Court of Audits (Dutch) Algemene Wet Bijzondere Ziektekosten AWBZ - Exceptional Medical Expenses Act (Dutch) Algemene Ziekenfondsen - General Sickness or Health-Insurance Funds (Dutch) Allgemeine Gewerbeordung - Common Labour Ordinance (German) Allgemeinen Versicherungsbedingungen AVB - General Conditions of Insurance (German) Allgemeines Landrecht - Common Law (German) Alterungsrückstellungen - old age provisions (German) Antirevolutionaire Partij ARP - Dutch Anti-Revolutionary Party Angestellten-Ersatzkassen - sickness funds for employees (German) Arbeiterersatzkassen - health insurance fund originally for blue-collar workers (German) Arbeitsgemeinschaft der Spitzenverbände der Krankenkassen - Association of Sickness Fund Organisations (German) Armenwet - Poor Law (Dutch) Artsenkamer - Physicians Chamber (Dutch)

19 12 TWO CENTURIES OF SOLIDARITY Assemblée - National Assembly (Belgian and French) Aufbaugesetz - Construction Law (German) Aufsichtsbehörde - district inspector (German) Beitragsentlassungsgesetz - Contribution Relief Act (German) Beirat - assistent manager (German) Belgisch Staatsblad - Belgian statute book Belgische Werkliedenpartij BWP - Belgian Workers Party Berliner Abkommen - German national treaty between sickness funds and physicians Besluitwet op de Maatschappelijke Zekerheid der Arbeiders - Social Security Act for Employed Workers (Belgian) Betriebskrankenkasse BKK - Company Health Insurance Fund (German) bos, bosse, bus, beurs - guild relief funds (Dutch, Belgian) Bureau de Bienfaisance- public welfare office (Belgian) Berufsgenossenschaften - institutions for statutory accident insurance and prevention (German) Besluitwet op de Maatschappelijke Zekerheid der Arbeiders - Social Security Act (Belgian) Besluit op de Ziekenfondsraad - Health-Insurance Council Decree (Dutch) Bond van R.-K. Ziekenfondsen - Alliance of Roman Catholic Health-Insurance Funds (Dutch) Bovenbouwverzekeraars, bovenbouwen - Private health insurers, related to sickness funds (Dutch) Bindend Besluit - Binding Resolution (Dutch) Bundesausschüss - Federal Committee of doctors and health-insurance funds (German) Bundesminister für soziale Sicherheit - Minister for Labour and Social Planning (German) Bundesministerium für Gesundheid - Federal Ministry of Health (German) Bundesrat - Federal Council comprising representatives of the Länder (German) Bundesverband - national federation of sickness funds (German) Bundesverfassungsgericht- Federal Constitutional Court (German) Burgerversicherung - universal health insurance (German) Centraal Overleg van Ziekenfondsorganisaties COZ - Central Consultation of Health- Insurance Fund Organisations (Dutch) Centraal Planbureau - Netherlands Bureau for Economic Policy Analysis (Dutch) Centrale Bond van Ziekenfondsen CBZ - Central Alliance of Health-insurance funds (Dutch) Centrale Commissie voor het Ziekenfondswezen - Central Commission for the Healthinsurance fund System (Dutch) Centrale Sociale Raad - Central Social Council (Dutch) Christelijk Historische Unie CHU - Christian Historical Union (Dutch) Christelijk Nationaal Vakverbond CNV- National Protestant Trade Union (Dutch) Commissie van Openbare Onderstand - Public Assistance Commission (Belgian)

20 TRANSLATIONS 13 Commissie-Dekker - Dekker Committee (Dutch) Controledienst voor de ziekenfondsen en de landsbonden van ziekenfondsen - Supervising Authority for Health-Insurance Funds and National Alliances of Health- Insurance Funds (Belgian) Corporatiewet - Corporations Act (Dutch) Directeur-Generaal van den Arbeid - Director-General for Labour (Dutch) directiefondsen - commercial sickness funds (Dutch) Ersatzkassen - health insurance fund originally for white-collar workers (German) Existenzrisiken - occupational hazards (German) Facultatieve aanvullende verzekering FAV - optional supplementary insurance (Belgian) Fallmanagers - care managers (German) Federatie van door Verzekerden en Medewerkers bestuurde Ziekenfondsen Federatie VMZ - Federation of Member- and Employer-Administered Health-Insurance Funds (Dutch) Federatie Vereenigde Maatschappij Ziekenfondsen Federatie VMZ - Federation of United Association Health-Insurance Funds (Dutch) Festbeträge - reference prices (German) Finanzausgleichsverfahren - financial equalisation (German) Freien Gewerkschaften - trade unions (German) Führer principle - managers principle (German) Gemeentewet - Municipalities Act (Dutch) Gemeenschappelijk Overleg van Ziekenfondsorganisaties GOZ - Joint Consultation of Health-Insurance Fund Organisations (Dutch) Gemeindekassen - municipal funds (German) Geneeskundig Staatstoezicht - State Health Inspectorate (Dutch) Geschäftsgruppe Soziale Verwaltung GSV - Coordination team for Social Affairs (Dutch- German) Gesetz über die Krankenversicherung der Landwirte - Legislation relating to health insurance for those employed in the agriculture sector (German) Gesetz über die Krankenversicherung der Studenten - Health-insurance act for students (German) Gesetz über die Sozialversicherung Behinderte - Social Security act for handicapped persons (German) Gesetz über Kassenarztrecht GKAR - Legislation for physicians contracting to sickness funds (German) Gesetz zur Reform des Risikostrukturausgleichs - Health Insurance Equalisation Fund Modernisation (German) Gesetzliche Kassen GKK - compulsory funds (German) Gesetzliche Krankenversicherung GKV - statutory health-insurance system (German) Gesetzliche Unfallversicherung - compulsory or statutory accident insurance (German) Gesundheits-Reformgesetz - Healthcare Reform Act (German)

21 14 TWO CENTURIES OF SOLIDARITY Gesundheits-Strukturgesetz - Healthcare Structure Act (German) Gesundheitsfonds - health-insurance fund (German) Gesundheitsreform - health system reform (German) Gewerbliche Gesetz betreffend die Krankenversicherung der Arbeiter KVG - Social Health Insurance Law for Labourers (German) gezellenbeurzen - journeymen s funds (Belgian) GKV-Modernisierunggesetzes - Health Insurance Modernisation Act (German) GKV-Neuordnungsgesetz- Statutory Social Health Insurance Restructuring Act (German) GKV-Wettbewerbsstärkungsgesetz GKV-WSG - Competition Reinforcement Health Insurance Act (German) Globalsteuerung und Budgetierung - Overall Control and Budgeting (German) Grundlohnsumme - base rate salary sum (German) Grundpauschal - nominal premium sum (German) Hartmann Bund, Leipziger Verband - doctors association (German) Hilfskassen - health-insurance funds (German) Hoge Raad van Arbeid - Higher Labour Council (Dutch) Hoge Raad voor Geneeskundig Toezicht - the High Council for Medical Supervision (Dutch) Hoofdbestuur HB - Executive Board of the Dutch Medical Association hospitaal, gasthuis - hospital (Dutch and Belgian) Hulpkas - Auxiliary Insurance Fund (Belgian) Innungskassen IKK - sectoral sicknessfunds (German) Instituut voor Geneeskundige Controle - Institute for Medical Control (Belgian) integrierte Krankenversicherung - universal health insurance (German) Integrierten Versorgung- integrated care (German) Karenzdagen - waiting days Kassenärztliche Bundesvereinigung KBV- National Association of Statutory Health Insurance Physicians (German) Kassenärztliche Vereinigung - Association of Statutory Health Insurance Physicians (German) Kassenärztliche Vereinigung Deutschlands - German Association of Statutory Health Insurance Physicians Kinderwetje - Child Labour Act (Dutch) Knappschafte - miners associations (German) Knappschaftsgesetz - Law on german miner s guild funds (German) Knappschaftskassen, Knappschaftsvereine - german miner s guild funds (German) Krankenhaus-Notopfer - copayment for hospital care (German) Krankheitsbezogenen Risikostrukturausgleich - morbidity-related equalisation fund (German) Kontaktkommissie Landelijke Organisaties van Ziektekostenverzekeraars KLOZ - Contact Body for Private Health Insurers (Dutch)

22 TRANSLATIONS 15 Konvergenzklausel - regional equalisation fund (German) Kopfpauschale - capitation fee (German) Kostendämpfungs-Erganzungsgesetz KEG- Health Insurance Cost-Containment Amendment Act (German) Krankenversicherung-änderungsgesetz KVAG- Health Insurance Amendment Act (German) Krankenversicherungs-Kostendämpfungsgesetz KVKG- Health Insurance Cost- Containment Act (German) Krankenversicherungsgesetz - Health Insurance Act (German) Landelijke Federatie ter Behartiging van het Ziekenfondswezen, Landelijke Federatie LFBZ - National Federation for the Promotion of the Health-Insurance Fund System (Dutch) Landelijke Huisartsen Vereniging LHV - National Association of General Practitioners (Dutch) Landelijke Specialisten Vereniging LSV - National Association of Medical Specialists (Dutch) Landesverbände - regional federations of sickness funds (German) Landelijke Contactcommissie van Onderling Beheerde Ziekenfondsen - National Contact Commission of Mutually Administered Health-insurance funds (Dutch) Landkrankenkassen LKK - regional sickness funds (German) Landsbond van Bedrijfs- en Onafhankelijke Ziekenfondsen LBBOZ - the National Union of Professional and Independent Health-Insurance (Belgian) Landsbond van de Beroepsmutualiteiten LBM- National Alliance of Occupation-Relation Mutualities (Belgian) Landsbond van Christelijke Mutualiteiten LCM - National Alliance of Christian Mutualities) (Belgian) Landsbond van Liberale Mutualiteiten - Alliance of Liberal Health-Insurance Funds (Belgian) Landsbond van Neutrale ziekenfondsen LNZ - Neutral Association of Health-Insurance Funds (Belgian) Landwirtschaftliche Krankenkassen - agricultural sickness funds (German) Leipziger Verband, Hartmann Bund - doctors association (German) Leiter - executive manager (German) Maatschappij tot Nut van t Algemeen - Society for Public Welfare (Dutch) Maatschappijfondsen - Association Funds (Dutch) Maximum-factuur - maximum charge system (Belgian) Medisch Contact - Medical Contact (Dutch) Medicijnknaak - copayment NLG 2.50 per medicine (Dutch) Middelburgsch Ziekenfonds - Middelburg Health-Insurance Fund (Dutch) Mindestleistung - minimum benefit (German) Minister van Arbeid en Nijverheid - Ministry of Labour and Industry (Belgian)

23 16 TWO CENTURIES OF SOLIDARITY Ministerie van Arbeid - Ministry of Labour (Dutch) Ministerie van Sociale Zaken - Department of Social Affairs (Dutch) Mutualités Libres - Onafhankelijke Ziekenfondsen MLOZ - Independent Health Insurance Funds (Belgian) Mutualiteitwet, Mutualitistische Wet (1851, 1894) - Mutuality Act (Belgian) Nationaal Hulp- en Voedingscomité NVHC - National Help and Nutrition Committee (Belgian) Nationaal-Socialistische Beweging NSB - National Socialist Movement (Dutch) Nationale Arbeidscommissie - National Labour Commission (Belgian) Nationale Kas voor Kinderbijslagen - the National Fund for Child Benefit (Belgian) Nationale Organisatie van Ziekenfondsen - National Organisation of Health-Insurance Funds (Dutch) Nationalsozialistische Deutsche Ärztebund NSDÄB - German National Socialist Physicians Organisation Nederlands Arbeidsfront NAF - Netherlands Labour Front Nederlands Onderling Herverzekeringsinstituut voor Ziektekosten NOZ - Netherlands Mutual Medical-Expenses Reinsurance Institute (Dutch) Nederlands Verbond van Vakverenigingen NVV - Dutch Association of Trade Unions Nederlandsche Maatschappij tot bevordering der Geneeskunst NMG - Dutch Medical Association Nederlandse Bond van Ziekenfondsen NBZ - Netherlands Health-Insurance Fund Alliance (Dutch) Nederlandse Unie van Ziekenfondsen - Netherlands Union of Health-Insurance Funds Nederlandse Vereniging van Ziekenfondsartsen NVVZA - Netherlands Association of Health-insurance fund Doctors nutsfondsen - sickness funds of the Society for Public Welfare (Dutch) Nutzersouveränität - consumer power (German) Ongevallenwet - Accident Act (Dutch) Openbare Centra voor Maatschappelijk Welzijn OCMW - Public Centres for Social Welfare (Belgian) Orde der Geneesheren - Order of Doctors (Belgian) Organisatie van Algemene Ziekenfondsen OAZ - Organisation of General Health- Insurance Funds (Dutch) Ortskassen, Ortskrankenkassen OKK - municipal or regional sickness funds (German) Overleg van Ondernemingsziekenfondsen - Consultation of Corporate Funds (Dutch) Palingoproer - Eel Revolt (Dutch) private Pflegeversicherung - private long-term healthcare insurance (German) Private Krankenversicherung PKV- private insurance (German) Pflegebedürftigkeit - level of care required (German) Pflegestützpunkte - care support offices (German) Pflegeversicherung - long-term care insurance (German)

TWO CENTURIES OF SOLIDARITY

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