De ziekenfondskwestie rond 1840: een Amsterdams of een nationaal probleem?

Abstract

A battle of the clubs in the Netherlands around 1840: was it a dispute specific to Amsterdam or was it national? The discovery of a national inquiry into health funds in the 1840s gives cause to reconsider the traditional view on this subject. After a prosperous period under the guild regime commercial interests penetrated the health market. Its directors supposedly enriched themselves at the expense of both the insured and the professionals (general practitioners (gp' s) and chemists). As things grew worse the government intervened and ordered an inquiry by a Select Committee. In reality things were slightly different. The debate on health insurance was part and parcel of the pursuit of the medical profession to improve its standing. An alarming report on health funds by the Amsterdam medical commission spurred the Health Department to action. The national inquiry did not in fact corroborate the earlier report. In most parts of the Netherlands health insurance did not exist. In only two provinces - North and South Holland - taking out a health insurance was an option and even there it was to a large extent in the cities. The three big cities - Amsterdam, Rotterdam and The Hague - accounted for 51.8 percent of all funds and as much as 72.2 percent of all persons insured. Nearly all complaints in the 1840s originated from gp's in Amsterdam. Only The Hague had the same experience i.e. infringements on private practice, enrichment by the fund governors etc. The complaints were not unlike those of the English club doctors at the end of the century. In both cities commercial health funds were important, while in Rotterdam gp' s had very often been founding fathers. The author has tried to put the complaints into a wider perspective by comparing commercial funds with local clubs' and gp's' own fund, the AZA, founded in 1847 to combat the disputed trend. Finally commercial funds have been compared with medical relief (number of patients and paid fees). The complaints about remuneration seem exaggerated as even AZA could not afford to pay higher fees. Commercialisation had only just started, but the new funds were more successful than the older clubs. AZA, however, proved to be even more successful. In close co-operation with poor law authorities a demarcation was introduced between medical relief and the working poor who had to take out a health insurance. AZA excluded the well-to-do from participating. Amsterdam developed a brand new health insurance policy in response to the threat of commercial funds. In the early twentieth century the story was repeated on a national level in response to proposals for compulsory sickness insurance.