Similar countries − different solutions

This research was planned as a comparative study of the structure and operation of the Belgian, German and Dutch national health-insurance systems. As J. van Langendonck emphasised in his talk at the 22nd Flemish Academic Economic Congress in 1995, it is very difficult to make an international comparison of social-security systems. If the researcher relies mainly on statistical information, such a comparative study is downright dangerous. Apparent similarities or differences in the figures are so strongly infl uenced by the differences in the national systems (range of application, risks covered, form of services, terms and conditions, administration) and by how the statistics are drawn up (definitions and categories used, source of the figures, counting periodicity, etc.) that in many cases no serious conclusions can be drawn.

These observations may hold true to an even greater extent in a comparison of the national healthcare insurance systems. Contribution percentages can be placed side by side, for example, but the calculations on which these percentages are based are highly dissimilar, not only due to the uneven application of maximum wage levels but mainly due to the different definitions of gross income, because of which the contribution requirement is not consistently applied in the case of a great many costs and remunerations. It is even more difficult to make comparisons over a period of almost two centuries. Criteria for calculating contributions (such as basic wage, gross wage, average wage) or the criteria for membership (such as individual or family insurance) were constantly being changed over the years, so that even the statistics from the same country cannot always be interpreted with precision and without ambiguity. For this reason, Van Langendonck advises that when making international comparisons of national social-security systems, it is important to consider aspects other than the purely quantitative. Since there has already been a reference in the introduction to the absence of reliable prewar statistics, this final chapter will concentrate on qualitative institutional characteristics and determinants, without ignoring the quantitative aspects.

As the first chapters of this study show, during the second half of the eighteenth century there was little difference in economic structure and level of prosperity between the western and southern regions of what was later Germany, the Austrian Netherlands (including the Prince-Bishopric of Liège) and the Republic of the United Provinces.