1. On the borders of the civil society? Private health insurance and civil society in the Netherlands 1900-2006 R.A.A. Vonk Posthumus conference 2010 21 May 2010, Leiden University KHZ, dept. Medical Humanities

2. To what extent did the interaction of public and private interests shape the private health insurance industry in the Netherlands during the period 1900-2006?

3. Private health insurance: a non-governmental, indemnity based insurance plan, whose scope is not limited by an income- threshold, that provides coverage for medical expenses due to illness or disability. KHZ, dept. Medical Humanities

4. Classic view Sickness fund as carriers of social health insurance (even before its official institution in 1941) Emphasis on inclusion (people, benefits, etc.) Abhorrence of profit-making Emphasis on solidarity Champions of the common good Private health insurance industry more concerned with making profit than with providing access to health care Emphasis on exclusion (benefits, people, etc.) Lust for profit and profit-maximization Emphasis on individualism Champions of free-marketeering KHZ, dept. Medical Humanities

5. Oddities - only minimal profits - inclusion of benefits and non-profitable ‘high- risk groups’ (i.e. risk-pooling) - emphasis on cooperation with government, medical professionals, sickness funds and other stakeholders KHZ, dept. Medical Humanities

6. statemarket individual Civil society : voluntary association justicedemocracy self-organization common good plurality diversity Civil Society: classic view

7. state market individual Civil society OHRA ONVZ D.E.L. De Verpleging ENZICO FBTO - Mutual NedLloyd VZVZ de Goudse Nationale Nederlanden - Commercial GAF Haarlem - Municipal VGCN Zilveren Kruis VGZ VGNN - Bovenbouw Sickness funds (c) Sickness funds (v) - Soc. HI Health insurance and civil society in the 20th century

8. -CS incorporates mutual health insurance schemes -As a sphere of emphasis on values of civility and public interests -CS does not incorporate: -statutory health insurance (state) -commercial/corporate health insurance (market) -bovenbouw insurance -blending of commercial and civil ideas and values in PHI -‘hybrid’ organizations Health insurance and civil society in the 20th century

9. Type / Year1950195519591960196519701975198019851986 Commercial574335424036 332925 Mutual3529252625 273332 Bovenbouw82840323539 403843 Total100 Source: F.T. Schut, Competition in the Dutch health care sector (1995) 139. Market share of health insurance carriers in percentages, 1950-1986

10. The dissolution of civil society and the blending of civicness statemarket Individual Civil society : voluntary association corporate social responsibility community services third sector service providers citizen initiatives informal groups consumer activism

11. The dissolution of civil society and the blending of civicness statemarket Individual Civil society VZVZ de Goudse Nationale Nederlanden - Commercial VGCN Zilveren Kruis VGZ VGNN - Bovenbouw OHRA ONVZ De Verpleging ENZICO FBTO - Mutual Sickness funds - Soc. HI GAF Haarlem - Municipal (K)NMG Consumentenbond Unions Patient org.

12. - takes into account the role of civil society, but has an emphasis on the borders between cs and the state, market and private sphere - allows for interaction and cross-fertilization of ideas and values between civil society other social spheres - framework to portray interaction between public and private interests - did civil society create a more ‘civil’ PHI-industry? The dissolution of civil society and the blending of civicness Benefits of ‘dissolution’-approach