Prevention: The cases of social security and healthcare

Abstract

In the member states of the European Union (EU) social security and healthcare systems have become important institutions. The welfare state – of which social security and healthcare represent the core and cornerstones – might even be considered to be one of the characteristics of these European states and societies. Yet these systems are not only very important institutions; they are also dynamic ones. During the last decades they have in fact been subject to far-reaching changes, in their practical operation but even more so in the reasoning about them. One of the discoveries has been the possible relevance of prevention and preventive action. But before dealing with the ins and outs of prevention we need some further clarifications on social protection, its major instruments, and logicsIn social protection traditionally two kinds of instruments are distinguished. Firstly there are replacement income schemes that are intended to secure an income in case primary earnings are interrupted as, for example, in the case of unemployment, sickness, or retirement. Secondly there are adjustment income schemes that are intended to meet exceptional expenditures such as, for example, those connected with children or medical care. Yet these systems are not magnanimous; they transfer income to beneficiaries only because a reason is found to do so (Gilbert et al., 1993). There are in fact two reasons – or bases of allocation, as they are called – that can be distinguished:Recognized social contingencies which are crucial for insurance-based schemes; and Need, which may open eligibility in assistance-like schemes.