The research analyzes through the comparative method, the answers that the law - as social science - is offering to the widespread problem throughout the Western world of a greater need for health care; (particularly) because of the insufficiency of public financial resources and of the lack of support from institutional bodies. In European countries, it is proved that it is not easy to satisfy the need to find the right balance between public and private, in the field of healthcare and the protection of fundamental rights. This requires complementarity and integration between operators. Starting from the analysis of the Italian system, the research compares some main systems and identifies legal solutions - always in the dichotomy between public and private - that can be usefully transplanted in Italy. The research unfolds through precise and fundamental guidelines. The first is devoted to a historical reconstruction of the welfare systems and to the various classification proposals that have been drafted over the years according to the existing macro-categories: (i) social sickness insurance, (ii) universal model and (iii) private insurance. This preliminary analysis leads to a first conclusion that there is no coherence between the classification of welfare systems and the concrete characteristics assumed by national health systems. In fact, welfare policies created differentiated systems, but they are not necessarily the expression of the political regimes within which they developed, so that the forms assumed are an expression of the complexity of the dynamics that influence the development of a single system. The second guideline is the analysis of some individual systems and the comparison among them. It is firstly considered the French model, which provides for the intervention of three main operators in the complementary assistance sector: mutual aid societies, social security institutions and insurance companies. From the analysis carried out, emerges a non-lucrative vocation of the system that reflects the solidarity approach to the themes of healthcare and protection, really rooted in France and characterized by an interventionist and guaranteeing State. The system is projected to the recognition of the rights of the patient, and the citizen is an active part of the system being involved in the economic aspects for a greater responsibility. Whereas the American system, the nature of which is completely opposite to the French universalist inspiration, represents a unique experience in the global context. Among the main stages of the US welfare, the following must be remembered: the Social Security Act of 1935 (a reform wanted by president Roosevelt through which the American system started experimenting with the idea of state subsidies); social protection programs (Medicare and Medicaid) mainly aimed at vulnerable people, and, lastly, the so-called Obamacare (made up of two provisions: the Patient Protection and Affordable Care Act, and the Healthcare and Education Reconciliation Act). The latter is a revolutionary reform, a constant source of attention in the US political landscape and the exceptions of constitutional illegitimacy raised have been verified, with particular attention to the balance between federal and state power. Balancing that is particularly expressed in the insurance sector which, in the narrowest field of health protection, sees the presence of various operators including insurance companies, mutual insurance companies, fraternal benefit societies and Health Care Sharing Ministries. Among these the last two are expressions of US particularism.

La ricerca indaga, attraverso gli strumenti della comparazione giuridica, quali risposte il diritto come scienza sociale stia offrendo al problema diffuso in tutto il mondo occidentale di una maggiore esigenza di assistenza sanitaria, anche e soprattutto quale conseguenza dell'insufficienza di risorse finanziarie pubbliche e della mancanza di supporto da parte degli organi istituzionali. Nei paesi europei è dimostrato come la necessità di trovare il giusto equilibrio tra pubblico e privato, nel campo della sanità e della tutela dei diritti fondamentali, sia tutt'altro che facile da soddisfare e richieda una complementarietà ed integrazione tra gli operatori. Partendo dall’analisi della situazione italiana, la ricerca pone a confronto alcuni principali sistemi mirando ad individuare soluzioni e strumenti giuridici – sempre nella dicotomia tra pubblico e privato - che possano essere utilmente trasporti in Italia. Il percorso di ricerca si snoda attraverso precise direttrici fondamentali laddove la prima è dedicata ad una ricostruzione storica dei sistemi di welfare ed alle varie proposte di classificazione che si sono succedute nel corso degli anni secondo le macrocategorie esistenti (i) assicurazione sociale di malattia, (ii) modello universalistico e (iii) assicurazioni private. Tale analisi preliminare conduce ad una prima conclusione secondo cui non esiste una coerenza fra la classificazione dei sistemi di welfare e le caratteristiche concrete assunte dai sistemi sanitari nazionali. Le politiche di welfare hanno infatti dato origine a sistemi differenziati, non necessariamente espressione dei regimi politici entro i quali si sono sviluppate, cosicché le forme assunte sono espressione della complessità delle dinamiche che influenzano lo sviluppo dei sistemi. Con riferimento ai singoli sistemi è stato preso in considerazione dapprima il modello francese il quale, nel settore dell’assistenza complementare, vede l’intervento di tre operatori principali: società di mutuo soccorso, istituti di previdenza e compagnie di assicurazione. Dagli approfondimenti effettuati, emerge una vocazione non lucrativa del sistema che rispecchia l’approccio solidaristico ai temi della salute e della tutela sanitaria, ben radicato in Francia e caratterizzato da uno Stato interventista e garantistica, proiettato al riconoscimento dei diritti del malato e ove il cittadino è parte attiva del sistema essendo previsto un suo coinvolgimento sul piano economico ai fini di una maggiore responsabilizzazione. Il sistema americano, avente natura completamente opposta rispetto alla ispirazione universalistica francese, rappresenta un’esperienza unica nel panorama globale. Tra le principali tappe del welfare statunitense debbono essere ricordate il Social Security Act del 1935 (riforma voluta dal presedente Roosevelt mediante la quale il sistema americano inizia a sperimentare l’idea di sussidi statali), i programmi di protezione sociale (Medicare e Medicaid) rivolti principalmente ai soggetti deboli, e, da ultimo, la cd. Obamacare (composta da due provvedimenti il Patient Protection and Affordable Care Act e l’Healthcare and Education Reconciliation Act). Quest’ultima si presenta come riforma rivoluzionaria, costante motivo di attenzione nel panorama politico statunitense ed in merito alla quale sono state verificate le eccezioni di illegittimità costituzionale sollevate con particolare attenzione al bilanciamento esistente tra potere federale e statale. Bilanciamento che si esprime in modo particolare nel settore assicurativo che, nel più ristretto campo delle tutele sanitarie, vede la presenza di svariati operatori tra cui compagnie di assicurazione, mutual insurance companies, fraternal benefit societies e, Health Care Sharing Ministries; tra cui gli ultimi due sono palese espressione del particolarismo statunitense.

(2020). Sanità, welfare privato e sistema pubblico: un’analisi comparata dall’Obama Care ai modelli europei. (Tesi di dottorato, Università degli Studi di Milano-Bicocca, 2020).

Sanità, welfare privato e sistema pubblico: un’analisi comparata dall’Obama Care ai modelli europei

ANZANELLO, LUCREZIA GIORGIA MARIA
2020

Abstract

The research analyzes through the comparative method, the answers that the law - as social science - is offering to the widespread problem throughout the Western world of a greater need for health care; (particularly) because of the insufficiency of public financial resources and of the lack of support from institutional bodies. In European countries, it is proved that it is not easy to satisfy the need to find the right balance between public and private, in the field of healthcare and the protection of fundamental rights. This requires complementarity and integration between operators. Starting from the analysis of the Italian system, the research compares some main systems and identifies legal solutions - always in the dichotomy between public and private - that can be usefully transplanted in Italy. The research unfolds through precise and fundamental guidelines. The first is devoted to a historical reconstruction of the welfare systems and to the various classification proposals that have been drafted over the years according to the existing macro-categories: (i) social sickness insurance, (ii) universal model and (iii) private insurance. This preliminary analysis leads to a first conclusion that there is no coherence between the classification of welfare systems and the concrete characteristics assumed by national health systems. In fact, welfare policies created differentiated systems, but they are not necessarily the expression of the political regimes within which they developed, so that the forms assumed are an expression of the complexity of the dynamics that influence the development of a single system. The second guideline is the analysis of some individual systems and the comparison among them. It is firstly considered the French model, which provides for the intervention of three main operators in the complementary assistance sector: mutual aid societies, social security institutions and insurance companies. From the analysis carried out, emerges a non-lucrative vocation of the system that reflects the solidarity approach to the themes of healthcare and protection, really rooted in France and characterized by an interventionist and guaranteeing State. The system is projected to the recognition of the rights of the patient, and the citizen is an active part of the system being involved in the economic aspects for a greater responsibility. Whereas the American system, the nature of which is completely opposite to the French universalist inspiration, represents a unique experience in the global context. Among the main stages of the US welfare, the following must be remembered: the Social Security Act of 1935 (a reform wanted by president Roosevelt through which the American system started experimenting with the idea of state subsidies); social protection programs (Medicare and Medicaid) mainly aimed at vulnerable people, and, lastly, the so-called Obamacare (made up of two provisions: the Patient Protection and Affordable Care Act, and the Healthcare and Education Reconciliation Act). The latter is a revolutionary reform, a constant source of attention in the US political landscape and the exceptions of constitutional illegitimacy raised have been verified, with particular attention to the balance between federal and state power. Balancing that is particularly expressed in the insurance sector which, in the narrowest field of health protection, sees the presence of various operators including insurance companies, mutual insurance companies, fraternal benefit societies and Health Care Sharing Ministries. Among these the last two are expressions of US particularism.
CERINI, DIANA VALENTINA
sanità; welfare; mutuo soccorso; assicurazione; comparazione
healthcare; welfare; mutual aid; insurance; comparazione
IUS/02 - DIRITTO PRIVATO COMPARATO
Italian
23-gen-2020
SCIENZE GIURIDICHE - 84R
32
2018/2019
open
(2020). Sanità, welfare privato e sistema pubblico: un’analisi comparata dall’Obama Care ai modelli europei. (Tesi di dottorato, Università degli Studi di Milano-Bicocca, 2020).
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/259334
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