Die Zukunft der Gesundheitssicherung / The Future of Health Care

In the past years, the financial deficit of the German Social Health Insurance System gave rise only to short-term measures of cost reduction while fundamental restructuring as a basis for long-term remedy has not occured. This can be partially explained by considering the political system and its penetration by special interests. Furthermore, systematic problems such as a lack of transparency concerning cost and quality of services are responsible for the current extent of inefficiency in the Social Health Care System, and this is of special relevance in respect to the overall state of the German economy. Strategies to improve performance of the system are, first, concerned with increasing its orientation towards patients’ needs and wishes. This requires insured people to be better informed and to have more decision-making power. Preference orientation must be the rule for allocating resources to health care provision as a whole and for allocation within this sector as well. Second, competition among health insurance funds must be intensified to improve quality and reduce cost. For this purpose, free contracting between insurance funds and service providers is required, and the frequently legally defined monopolistic market structures are to be dissolved. Finally, institutional structures such as payment systems and the extent of individual responsibility are of substantial relevance for being able to cope with future, in particular demographic, challenges to Social Health Insurance.