↳ Hospitals

February 18th, 2020

↳ Hospitals

The Importance of Being Evergreen


A comparative overview of national healthcare systems

In an employer-sponsored healthcare system like that of the United States, deteriorating labor market protections have immediate consequences for access to healthcare. Democratic primary candidates have presented a number of proposals to address declining rates of insurance, ranging in degrees of accessibility, coverage, and number of providers.

In her 1992 book, Healthcare Politics, ELLEN M. IMMERGUT seeks to explain America's healthcare system through a comparison of its history to Switzerland's, France's, and Sweden's. From the author's preface:

"I compare the politics of three countries where national health insurance had been proposed, but where, as a result of political struggles, the final policy results are diverse. Medical associations in all three countries had opposed national health insurance on the grounds that doctors preferred to work as private practitioners and not as government employees. How then could one explain the fact that Switzerland rejected national health insurance, France accepted it, and Sweden not only enacted national health insurance, but later converted its health system to a de facto national health service? The history of each case pointed insistently to the role played by standard political institutions. The Swiss referendum, the French parliament, and the Swedish executive bureaucracy emerged as key elements in an explanation of national health insurance politics in those countries.

The resulting book argues for the primacy of these institutions in explaining policy outcomes precisely because they facilitate or impede the entry of different groups into the policy-making process. In Switzerland, the public interest on any specific policy issue is viewed as the sum of the demands of individual citizens as expressed in national referenda. In Sweden, on the other hand, proper representation for policy issues is a matter of consensual agreements between interest groups, whose large memberships and democratic procedures ensure their responsiveness to the public. In France, the rules of representation stress the importance of an impartial executive standing above the particularistic claims of interest groups. But there is no linear relationship between a specific set of political institutions and the interest groups that will succeed or the health system that results. These histories are filled with unexpected events, sudden about faces, and new strategies. This book is a call to look at these histories, not just at the broad sweep of major events, but also at the seemingly minor struggles that make up daily political life. These are the battles that establish the constraints on politics, but they are also the junctures that extend the limits of the possible."

Link to a downloadable copy of the book.

  • "The postwar growth of public expenditures in the health sector and the growth of universalism in coverage of benefits is tied to the strength of the labor movement in each country." Vincent Navarro's influential 1989 paper situates healthcare policies within a broader distributional framework. Link.
  • "The idea of a British hospital system funded by its users is one which emerged only late in the 19th century. Before this, care was provided through thousands of voluntary hospitals." Martin Gorsky, John Mohan, and Tim Willis on "Mutualism and Healthcare" in the UK. And in a similar vein, David T. Beito's 2000 book on the fraternal societies which provided healthcare to millions of Americans throughout the 19th and early 20th centuries. Link and link.
  • A recent paper by Stefan Bauernschuster, Anastasia Driva, and Erik Hornung uses "the introduction of compulsory health insurance in the German Empire in 1884 as a natural experiment to study the impact of social health insurance on mortality," finding that "Bismarck’s health insurance generated a significant mortality reduction." Link.
⤷ Full Article