[Between merit and need: an analysis of the underlying principles in social health insurance in Germany].
This article describes and analyzes the structural principles of social health insurance in Germany and discusses their interrelations and current form. Focusing on salaried work, social security in Germany links rights and duties to the place occupied by workers in the production process and maintains a differentiation in their status. As a paradigm of social security, citizens' social rights in Germany are organized according to principles of equivalence, subsidiarity, and solidarity. The coexistence of these contradictory principles generates a constant field of tension and conditions their effect, thus mediating how each one is implemented. This tension, which has always existed in the underlying system, is reedited each time the political context changes. While subsidiarity and equivalence prevailed in the original social security system, the solution to the conflict tended towards solidarity during the expansion of welfare states and social health insurance. At present, however, there is a call for reediting subsidiarity and equivalence.
Giovanella
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Núcleo de Estudos Político-Sociais em Saúde, Departamento de Administração e Planejamento em Saúde, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Av. Brasil, 4036, sala 616, Rio de Janeiro, RJ 21040-361, Brasil.
D005858:Germany; D006291:Health Policy; D006801:Humans; D011640:Public Policy; D012943:Social Security / Q000639:trends*