The health and medical-expenses insurances funded from premiums in countries such as the Netherlands, Belgium, Germany, Hungary and Poland are an important part of modern-day social security within the European Community, in addition to the care systems financed from tax revenue, as in England, Spain, Italy and the Scandinavian countries.1 The insurance institutions in the various countries insure millions of people, receive and pay out billions of euros each year, and are major employers.

Modern health-insurance funds and health-insurance companies are an essential link in this gigantic and complex whole. Many outsiders – as well as people who live and work within the world of insurance – do not realise that these modern institutions have a fascinating history that extends back over many centuries, and that, even today, traces of this history are visible in the organisation of health insurance, national health-fund structures and the activities of health-insurance funds. The social insurance systems implemented by health-insurance funds have their roots in Western Europe. In countries such as the Netherlands, Belgium and Germany, some of the large-scale health-insurance funds – with hundred of thousands or even millions of insured persons – owe their existence to modest local initiatives taken in the nineteenth century, when groups of people with a social conscience (e.g. community leaders, employers, physicians) worked together to provide more secure financial circumstances and medical care for those in need. Elsewhere, it was the artisans or labourers themselves who joined forces to build an independent mutual support fund from their modest wage. It is this historical continuity and geographical proximity that enable us to compare the development of health insurance in Germany and Belgium with that of the Netherlands.

After the Second World War, in the highly developed Western countries and against a background of unprecedented economic growth, modern welfare states were rapidly established. During the 1970s, however, economic expansion slowed, prompting a broad social discussion about social security. Was the organisational structure still appropriate for an industrial economy that was evolving into a service economy? Was it not so that cumbersome and bureaucratic implementing bodies, such as the health-insurance funds, were swallowing up too much money? And, above all, would the greatly extolled social-security system – which supported every citizen from the cradle to the grave – remain affordable in the future?