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https://doi.org/10.12759/hsr.46.2021.1.35-58
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Erosion of Solidarity in France and Welfare Conventions: The New Role of Complementary Health Insurance
Erosion der Solidarität in Frankreich und Wohlfahrtskonventionen: Die neue Rolle der Zusatzkrankenversicherung
[journal article]
Abstract The French health system has been structurally in crisis since the early 1980s. This crisis is reflected in the loss of legitimacy of the conventional Fordist vision of national solidarity, which is characterized by a "crisis of legitimacy." The Fordist convention has the particularity of correspond... view more
The French health system has been structurally in crisis since the early 1980s. This crisis is reflected in the loss of legitimacy of the conventional Fordist vision of national solidarity, which is characterized by a "crisis of legitimacy." The Fordist convention has the particularity of corresponding to a harmonious representation of social justice between the different orders (economic, political, and domestic) of social protection. Contemporary criticism of the health care system uses what was once the basis of institutionalized compromise between orders. The result is a new role for supplementary health insurance. This new role overturns the concept of solidarity that characterizes health policies. A new conventional vision is emerging: the liberal convention. This analysis focuses on the French case where complementary insurance has historically fulfilled solidarity missions. The new status of supplementary protection is accompanied by an unequal drift, which cannot be seen as the expression of a natural antagonism between economic efficiency and social justice. In France, expenditure has remained high while inequalities have increased. These limits have led the legislator to modify its policy by exempting certain patients from contributing to the financing of their own health expenditure. These sensitive adjustments are costly when the initial objective is to reduce expenditure and tend to generate new inequalities.... view less
Keywords
health insurance; supplementary insurance; health care delivery system; France; health policy; inequality; solidarity
Classification
Health Policy
Free Keywords
Economics of convention; health system; concept of solidarity; complementary health insurance; welfare conventions
Document language
English
Publication Year
2021
Page/Pages
p. 35-58
Journal
Historical Social Research, 46 (2021) 1
Issue topic
Conventions, Health and Society - Convention Theory as an Institutionalist Approach to the Political Economy of Health
ISSN
0172-6404
Status
Published Version; peer reviewed