New Welfare in Health Insurances? Trends in Risk­ Coverage and Self­Responsibility in Four European Countries

Introduction. In the current economic and financial crisis, many European governments are debating cuts in healthcare costs. These debates, on the one hand, have a financial perspective, with cutting healthcare costs the highest ambition. On the other hand, they also have a moral perspective, for example when dealing with the coverage of lifestyle related health risks like binge drinking or smoking. Increasingly, the ideas of ‘positive’ or ‘new’ welfare are included in this discussion. Promoting a healthy lifestyle is stimulated or even financially rewarded in many domains of European welfare states, including healthcare (Department of Health, 2004; Jochelson, 2007; Fenger, 2009, 2011; Oliver and Brown, 2011; English, 2012). This article sets out to explore in what ways the ideas of the social investment state and positive welfare have affected the coverage of healthcare costs in European countries. As systematic comparative information about this topic is scarce, this article fills an important knowledge gap. There is an abundance of information to be found about distinct European healthcare systems, healthcare provision structures, their financial management, level of reimbursements, out-pocket-payments and the like. However, a systematic overview of changes in health insurance coverage is lacking. This prevents an analysis of the underlying trends in European healthcare systems. Is healthcare coverage changing in European countries? And, if so, can we observe a general trend towards more preventive and pro-active coverage of health risks, as we might assume from the ‘positive welfare’ perspective? Or are changes in healthcare coverage more randomly distributed and inspired by financial rather than moral arguments? By answering these questions this article contributes to the overall ambitions of this themed section: exploring how the ideas of positive welfare have been implemented in practice and identifying important trends and dilemmas.

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