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The Scandinavian welfare model shows cracks

In Scandinavia, the State guarantees welfare and health services for all citizens. However, the actual disparities in health are greater than the rest of Europe.
UNDERLYING FACTS: Social, historical and cultural factors can explain the Scandinavian health disparities. These are difficult for the welfare state to even out. Photo: Digital Vision
UNDERLYING FACTS: Social, historical and cultural factors can explain the Scandinavian health disparities. These are difficult for the welfare state to even out. Photo: Digital Vision

The figures are clear: It’s not Scandinavia, but Germany, France, Switzerland and the Benelux countries that have the smallest disparities in the health of their citizens. The reported figures are based on citizens’ self-perceived health experiences and the comparisons have been made within each country.

Terje Andreas Eikemo at SINTEF Health Research has completed a doctoral thesis on this issue. Based on data from the European Social Survey, Eikemo has carried out the largest quantitative, comparative health investigation ever implemented.

State, family or market

He has assessed different welfare models from the point of view of the division of responsibility between the State, the family and the market.

“In Scandinavia, we contribute through relatively high taxes and fees and know that in return the State will take care of us if we get into difficulties,” says Eikemo. “In Southern Europe, the family constitutes the security net; in Great Britain the market is important with private health insurance options while in Central Europe benefits are based on previous earnings.”

Explanations

The fact that there are greater  differences in citizen health in Scandinavia than Central Europe may be attributed to several factors. Eikemo believes that underlying social, historical and cultural factors create differences in the starting point. This makes it difficult for the welfare state to remedy matters afterwards.

Eikemo also points to recent immigration as an explanation for the discrepancy. These are people with few resources who do not use the health services to a major degree.

“Health is a good gauge of whether a welfare state is functioning,” says Eikemo. “England has special focus on health for the lowest echelons of society. In Norway, we have an equality ideal where we are preoccupied with the outcome of good health care being equal for everyone.

Since the principle of equality appeals most to Norwegian politicians, these figures should be of interest,” says the SINTEF research scientist, who has published extracts of his thesis in several international journals.

By Åse Dragland

Published 24 September 2008

Contact

Terje Andreas Eikemo