This volume, Two centuries of solidarity. German, Belgian and Dutch social health insurance 1770- 2008, is an updated and translated edition of Twee eeuwen solidariteit. De Nederlandse, Belgische en Duitse ziekenfondsen tijdens de negentiende en twintigste eeuw, published in 2001 by the Stichting Historie Ziekenfondswezen (Stichting HiZ; Foundation for the History of Health Insurance) in close cooperation with Aksant Academic Publishers.

In most EU-countries the system of structuring and financing healthcare is in a constant state of change. The division of roles between state, health insurers, care providers and consumers is changing. The introduction of regulated competition, the re-regulation of supervision and prices and an orientation towards consumer-driven healthcare, cost containment and sustainability are key-concepts in the political restructuring-effort of healthcare and social security.

How these adaptations will develop in the upcoming decennia is uncertain. They not only depend on national political and social relations, but also on the infl uence of supranational legislation by the European Union. How health insurance will function in 2020 is unforeseeable. At present, ‘Europe’ has no direct jurisdiction on the national systems of healthcare and social security of its 25 member states. The principle of subsidiarity, laid down in the Treaty of Rome (1957) and reconfirmed in the Treaty of Amsterdam (1999), stipulates that health insurance and the structure of healthcare are a matter of the individual member states. The core of the European Union, though, is its free internal market. The infl uence of the EU on national systems of healthcare and social security is therefore indirect, but unmistakably present. Prime examples of this infl uence are the rulings of the European Court of Justice in the renowned Decker/Kohl-arrests, enabling the provision of transnational healthcare. The European Parliament wishes to strengthen this development.

The frontiers between national systems of healthcare and health insurance will probably fade in the future. This brings the risk that knowledge of these national systems and the lessons that can be drawn from them will be lost. Bearing this in mind the Stichting HiZ and the Kenniscentrum Historie Zorgverzekeraars (Centre for the History of Health Insurance) wanted to publish a comparative historical study to document and analyse the characteristics and strengths and weaknesses of the system of health insurance in the Netherlands and other EU-countries.