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Policymaking without Policy Choice: The Rise of Private Health Insurance in Denmark

Published online by Cambridge University Press:  22 October 2009

Abstract

Policymaking and policy outcomes are not necessarily the result of a carefully designed process but can result from intertwined political and institutional dynamics that are often difficult to predict from the outset. This article examines such a policy process, the dramatic rise in the uptake of private health insurance (PHI) in Denmark. In a comprehensive welfare state, founded on the principle of universalism, its success is puzzling. The explanation suggested here is that the rise in PHI is an example of policymaking without policy choice. The article reviews the intended and unintended effects concerning equality in health care and public finance. It also notes that the introduction of a private alternative to the universal health care system has not weakened the support for the public services.

Type
Research Article
Copyright
Copyright © Cambridge University Press 2009

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References

3F. (2006). Offentligt ansatte vil have fryns: 3F nyheder, 07.02.2006, available at www.3f.dk.Google Scholar
3F. (2007). Hver femte 3F'er har arbejdsgiverbetalt sundhedsforsikring: 3F Nyheder, available at www.3f.dk.Google Scholar
Andersen, I. H. and Madsen, T. N. (2008). Medlemmer vil forsikres – fagbevægelsen siger nej. Ugebrevet A4.Google Scholar
Andersen, J. G. (2000). Borgerne og sygehusene. Center for komparative velfærdsstatsstudier, Ålborg Universitet.Google Scholar
Andersen, J. G. (2003). Over-Danmark og under-Danmark? Ulighed, velfærdsstat og politisk medborgerskab. Aarhus: Aarhus Universitetsforlag.Google Scholar
Besley, T., Hall, J. and Preston, I. (1999). The demand for private health insurance: do waiting lists matter? Journal of Public Economics, 72, 155181.CrossRefGoogle Scholar
Birkemose, J. (2002, 06.05). Fra velfærd til forsikring. Ugebrevet A4.Google Scholar
Blomqvist, P. and Rothstein, B. (2005). Välfärdsstatens Nya Ansikte: Demokrati och Marknadsreformer inom den Offentliga Sektorn. Stockholm: Agora.Google Scholar
Christiansen, T., Enemark, U., Clausen, J. and Poulsen, P. B. (1999). Health care and cost containment in Denmark. In Mossialos, E. et al. (Eds.), Health Care Cost Containment in the European Union. England: Ashgate: Aldershot.Google Scholar
Colombo, F. and Tapay, N. (2003). Private Health Insurance in Australia: A Case Study. Paris: OECD Publishing.Google Scholar
Costa, J. and Garcia, J. (2003). Demand for private health insurance: how important is the quality gap? Health Economics, 12, 587599.CrossRefGoogle ScholarPubMed
DEC. (2007). Danish Economy, Autumn 2007. Copenhagen: Danish Economic Councils.Google Scholar
Esping-Andersen, G. (1990). The three worlds of welfare capitalism. Cambridge, UK: Polity Press.Google Scholar
Finansministeriet. (1998). Borgerne og den offentlige sektor. København: Finansministeriet.Google Scholar
Gingrich, J. R. (2007). Whose Market is it Anyways: Mutible Markets in the Welfare State. Unpublished Ph.D thesis, University of California Berkeley.Google Scholar
Glavind, N. (2008). De svage grupper er ikke med i de private sundhedsforsikringer. Copenhagen: Economic council of the Labour Movement.Google Scholar
Hacker, J. S. (2002). The divided welfare state: the battle over public and private social benefits in the United States. New York: Cambridge University Press.CrossRefGoogle Scholar
Hall, P. A. (2003). Aligning Ontology and Methodology. In Mahoney, J. et al. (Eds.), Comparative Historical Analysis in the Social Sciences. New York: Cambridge University Press.Google Scholar
Hebsgaard, T. (2007, 08.09). Sundhed: Den skjulte revolution: Den syge, der kom frem i køen. Information.Google Scholar
Helderman, J.-K. (2007). Bringing the market back in?: Unpublished Doctoral Thesis, Radboud University Nijmegen.Google Scholar
Hurst, J. and Siciliani, L. (2003). Tackling Excessive Waiting Times for Elective Surgery: A Comparison of Policies in Twelve OECD Countries: OECD Publishing.Google Scholar
Immergut, E. M. (1992). Health Politics. Interest and institutions in western Europe. New York: Cambridge University Press.Google Scholar
Iversen, C. (2007, 20.08). De udsatte får ingen sundhedsforsikring. Berlingske tidende.Google Scholar
Jensen, J. W. (2007). Forebyggelsesplan – nu med mere ulighed. Tillæg til Ugeskrift For Læger nr. 46/2007, 46.Google Scholar
Kjær, P. and Pedersen, O. (2001). Translating Liberalization: Neoliberalism in the Danish Negociated Economy. In Campbell, J. L., et al. (Eds.), The Rise of Neoliberalism and Institutional Analysis. New Jersey: Princeton University Press.Google Scholar
L97: Forslag til lov om ændring af ligningsloven (Skattefrihed for arbejdsgiverbetalte sundhedsbehandlinger), 2001–2002, 2. samling. The Danish Parliament. Available at www.ft.dk C.F.R. (2002).Google Scholar
L149: Forslag til lov om ændring af ligningsloven (Skattefrihed for arbejdsgiverbetalte ydelser til alkohol afvænning), The Danish Parliament. Available at www.ft.dk C.F.R. (1999).Google Scholar
LO. (2003). LO stærkt utilfreds med skattefri sundhedsforsikringer (Publication. Retrieved 19.dec. 2007, from LO nyheder at www.lo.dk.Google Scholar
Maarse, H. (Ed.). (2004). Privatisation in European Health Care. A comparative analysis in eight countries. Maarssen: Elsevier.Google Scholar
Ministry of Health and Internal Affairs. (2007). Sundhedssektoren i tal, juni 2007.Google Scholar
Ministry of Taxation, M. o. F., Ministry of Employment, Ministry of Economic and Business Affairs. (2007). Statusrapport til Folketinget om personalgoder/naturalieydelser. Available at www.skm.dk.Google Scholar
Mooney, G. (2002). The Danish health care system: it ain't broke…so don't fix it. Health Policy, 59, 161171.CrossRefGoogle ScholarPubMed
Mossialos, E. and Grand, J. L. (Eds.). (1999). Health care and cost containment in the European Union. Aldershot: Ashgate.Google Scholar
OECD. (2004). Private health insurances in OECD Countries. Paris: OECD.Google Scholar
OECD. (2006). OECD Health database. In E. o. t. 14.03.2007 (Ed.).Google Scholar
OECD. (2007). Health at a Glance 2007, OECD indicators. Paris: OECD.Google Scholar
Olsen, L. (2007). Sundhedsforsikringer er især for eliten. Ugebrevet A4.Google Scholar
P.N. (2001, 14. februar 2001). Usolidarisk SID-forslag. Dagbladet Arbejderen.Google Scholar
Pedersen, K. M., Christiansen, T. and Bech, M. (2005). The Danish health care system: evolution – not revolution – in a decentralized system. Health Economics, 14, 4157.CrossRefGoogle ScholarPubMed
Petersen, K. M. (2005). Sundhedspolitik. Beslutningsgrundlag, beslutningstagen og beslutninger i sundhedsvæsenet. Odense: Syddansk Universitetsforlag.Google Scholar
Pierson, P. (1994). Dismantling the welfare state? : Reagan, Thatcher, and the politics of retrenchment. Cambridge, England; New York: Cambridge University Press.CrossRefGoogle Scholar
Pierson, P. (2000). Increasing Returns, Path Dependence and the Study of Politics. American Political Science Review, 94 (2), 251268.CrossRefGoogle Scholar
Propper, C. and Green, K. (2001). A Larger Role for the Private Sector in Financing UK Health Care: the Arguments and the Evidence. Journal of Social Policy, 30 (4), 685704.CrossRefGoogle Scholar
Rechnagel, U. (2007, 08.10). Sundhedssikring bliver en fast del af lønnen. Børsen, p. 28.Google Scholar
Rose, R. and Karran, T. (1987). Taxation by political Inertia. Financing the growth of government in Britain. London: Allen and Unwin.Google Scholar
Rothstein, B. (1998). Just Institutions Matter: The Moral and Political logic of the Universal Welfare State. New York: Cambrigde University Press.CrossRefGoogle Scholar
Saliba, B. and Ventelou, B. (2007). Complementary health insurance in France Who pays? Why? Who will suffer from public disengagement? Health Policy, 81, 166182.CrossRefGoogle ScholarPubMed
Schneiberg, M. (2007). What's on the path? Path dependence, organizational diversity and the problem of institutional change in the US Economy, 1900–1950. Socio-Economic Review, 5, 4780.CrossRefGoogle Scholar
Steinmo, S., Thelen, K. A. and Longstreth, F. (Eds.). (1992). Structuring politics : historical institutionalism in comparative analysis Cambridge; New York: Cambridge University Press.CrossRefGoogle Scholar
Streeck, W. and Thelen, K. A. (Eds.). (2005). Beyond continuity : institutional change in advanced political economies. Oxford: Oxford University Press.Google Scholar
Taylor-Gooby, P. (1999). Commitment ot the Welfare State. In Jowel, R. (Ed.), British – and European – Social Attitudes. How Britain Differs. Aldershot: SCPR/Ashgate.Google Scholar
TCU. (2004). The Christian Union: Improvements of the pension agreement. News from the Christian Union. Available at www.krifa.dk.Google Scholar
Thelen, K. (2004). How Institutions Evolve. The Political Economy og Skills in Germany, Britain, the United States, and Japan. New York: Cambridge University Press.Google Scholar
Timmins, N. (1995). The Five Giants. A Biography og the Welfare State. London: Harper Collins.Google Scholar
Tountas, Y., Karnaki, P., Pavi, E. and Souliotis, K. (2005). The ‘unexpected’ growth of the private health sector in Greece. Health Policy, 74, 167180.CrossRefGoogle ScholarPubMed
UgebrevetA4. (2002, 30.09). Lønmodtagere vil have private sundhedsforsikringer.Google Scholar
Vallgårda, S. and Krasnik, A. (Eds.). (2007). Sundhedsvæsen og Sundhedspolitik. København: Munksgaard Danmark.Google Scholar
Vennesson, P. (2007). Case studies and process tracing: Theories and practices. Unpublished manuscript, EUI, Florence.Google Scholar
Vrangbæk, K. (2004). Ingeniørarbejde, hundeslagsmål eller hovedløs høne? Ventetidsgarantier til sygehusbehandling. Århus: Århus University.Google Scholar
Wildavsky, A. (1977). Doing better and feeling worse: the political pathology of health policy. Daedalus: Journal of the American Academy of Arts and Sciences, 106, 105123.Google Scholar