5 The Principle of Solidarity in Health Care Systems
The diversity of social security systems in various states is reflected in the diversity
of health care systems as well. However, all modern health care systems are based
on principles of universality and solidarity. Whereas universality entails full terri-
torial and personal coverage, as well as equal accessibility, solidarity as a legal and
structural principle implies a legally enforceable obligation of each individual to
contribute to the functioning and financing of the health system.^36 Absence of
equivalence between contributions and benefits is one of the most salient aspects
of the principle of solidarity. The principle of solidarity is the most important point
of convergence between various health care systems in the EU.^37 Hatzopoulos
identifies three levels on which solidarity operates: at the level of integration into
the system, at the level of financing, and at the level of benefits.^38 The principle of
solidarity is at the core of systems based on compulsory health insurance, where it is
implemented precisely through obligation of insurance.^39
The question that arises is: what consequences would the introduction of per-
sonalized medicine in compulsory health insurance systems have? Is it possible and
would it destruct or reconstruct the essential features of compulsory health insur-
ance? Would it be accessible to all or just certain groups of insured persons and to
which extent? These and other concerns naturally lead to the question of cost
efficiency and market potential of compulsory health insurance. How will this
affect solidarity and the absence of equivalence?^40 Which benefits would be left
to be covered directly by insured persons? Which benefits are worthy of solidarity?
It seems that the already overstrained, classic financing mechanisms for com-
pulsory health insurance will not be capable of covering the expenses in connection
with personalized medicine. Will this lead to privatization of risks, unleash the
desolidarization process, or devalue the principle of solidarity?^41
6 Health Insurance and Personalized Medicine
The question of health insurance and personalized medicine deserves a closer look.
Disputes and challenges surrounding personalized medicine will certainly be
manifested differently in the current compulsory health insurance, which is
(^36) For a definition of the principle of solidarity, see, e.g., Kingreen ( 2003 ), Martinovic ́( 2014 ), and
Hatzopoulos ( 2009 ).
(^37) Martinovic ́( 2014 ), p. 56.
(^38) Hatzopoulos ( 2009 ), p. 769.
(^39) Kingreen ( 2003 ), p. 252.
(^40) On the tension between personalised medicine and basic principles of compulsory health
insurance, see M€uller ( 2012 ) and Raspe ( 2012 ).
(^41) See more in Martinovic ́( 2014 ).
Challenges of Personalized Medicine: Socio-Legal Disputes and Possible Solutions 39