Solidarity: who cares?

This contribution describes the principal forms of solidarity in the healthcare sector. We discuss the concept of solidarity and its diverse roles as well as the design of the existing solidarity framework and trends for the future. Solidarity in healthcare is under pressure: the costs are rising and the distribution of solidarity transfers is becoming increasingly uneven, socio-cultural trends are sending out mixed signals and many think it is fair to ask people with unhealthy lifestyles to pay more. However, a fully funded system is less suited to healthcare than to supplementary pensions. In healthcare, more so than in the pension sector, solidarity is nurtured by feelings of community and justice. At the same time, egalitarian outcomes are increasingly difficult to achieve due to the evermore uneven distribution of the health cost burden, the enormous supply of healthcare products and the large mutual differences in the production process.