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Case 5 health systems governance
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Description of case 5 of health systems governance
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Case 5Learning goals
1. How do sociological theories on solidarity explain this concept, and what motives for
solidary behaviour can be derived from these theories?
What is solidarity?
Solidarity and forms of solidarity
1. Solidarity: that which binds individuals into a relatively autonomous society, or negatively
stated, that which prevents the disintegration of a society.
2. Solidarity: the willingness to protect those human persons whose existence is threatened by
circumstances beyond their control, particularly natural fate or unfair social structures.
3. Solidarity suggests a sense of community and the willingness to bear the consequences of
community membership – it implies a certain bond.
The classic sociologists Durkheim and Weber saw solidarity as the social cohesion arising from a
sense of shared fate between individuals and groups.
The most important solidarity concepts in healthcare are income solidarity and subsidising solidarity.
SHARED IDENTITY AND SHARED UTILITY ON SOLIDARITY AND ITS MOTIVES
Wim van oorschot
Motives:
The conclusion will be that solidarity can be defined as an actual state of interrelations between
individuals, groups and the larger society, which enables the common good of groups and society to
be served.
The essence of and basis for such relations is that people have or experience a common fate,
either because they share identity as members of the same collectivity and therefore feel a
mutual sense of belonging and responsibility, or because they share utility: they need each
other to realise their life opportunities.
Another conclusion will be that such a state basically rests upon either a shared identity (`we are
one') or a shared utility (`we need each other'). This implies that the strength and range of a system's
solidarity is a function of the nearness and dependence among the social actors it embraces, which in
turn leads us to argue that people can have four different motives to support an actual state or
relation of solidarity:
1. Mutual affection and identification (Mayhew’s view, shared identity) The degree to which
people feel attracted to one another and are loyal at the micro level, and the degree to
which they perceive a collective identity and we-feeling at the meso and macro level are
decisive for the solidarity between them.
macro and micro level
2. Moral convictions (Durkheim and Parsons view) Culturally-based convictions, which imply
that the individual feels a moral obligation to serve the collective interest and to accept
existing relations of solidarity.
, 3. Perceived self-interest (Hechter’s view, and Dukrheim’s, shared utility Rational choice based
approach. People learn that they benefit from contributing to the collective interest (if not
immediately then in the long run).
- macro and micro level
4. Accepted coercion (dwang) (External view, if nothing works in solidarity principles, then this
motive) Contributing to the collective interest is an act of solidarity only if it results from institutional
role obligations. Purely voluntary contributions do not bind, they lack true commitment. Hechters
ending: fair of sanctions. Example: if a child is not solidary to brother, a mother says child should
share eventually solidarity (if there are no moral convictions or moral obligations)
- unforced by the state taxes is a good example
Non-solidarity: you pay a premium according to your risk. So, people with a higher risk profile pay
more. It would be unjust to force a group or person to pay for the needs/burdens of others. It is
unfair, because it reduces access to life opportunities and increases suffering for those disadvantaged
by risk, pain, and illness.
Forms of solidarity
, Conclusion
Another conclusion will be that such a state basically rests upon either a shared identity (`we are
one') or a shared utility (`we need each other'). This implies that the strength and range of a system's
solidarity is a function of the nearness and dependence among the social actors it embraces, which in
turn leads us to argue that people can have four different motives to support an actual state or
relation of solidarity
Essence / basis for relations: people have or experience a common fate, either because they
share identity as member for the same community and therefore feel a mutual sense of
belonging and responsibility, or because they share utility: they need each other to realise
their life opportunities
Homo sociologicus:
homo sociologicus, in which individuals are seen as essentially social beings, who act in accordance
with their affections for others and internalised cultural norms and values
o Humans as essentially social beings
o Act according to their affections for others
o Internalised cultural norms and values
Homo economicus:
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