Nutzer im Gesundheitswesen: Koproduzenten zwischen Autonomieansprüchen, Kompetenzanforderungen und Verunsicherung

The German health care system shifts gradually towards economization, marketization and knowledge-based services which increases the complexity of health care provision. While being quite contradictory in its outcomes, these changes share a strong impact towards the activation of health care users. Particularly, health care providers address users in various roles at the same time, for instance, users have to act as co-producing patients and consumers simultaneously. Applying a concept of „multiple identities of users“, three key areas of the German health care system are scrutinized: the choice of providers and tariffs within the Statutory Health Insurance (SHI) system, dental treatment and funding of dental prosthesis and, more generally, the physician-patient-relationship. Drawing from expert interviews at user organizations, the paper demonstrates that health care users are increasingly challenged as involuntary co-producers and, hence, are struggling to maintain their personal values and priorities. However, users have strong feelings of uncertainty despite having competences in the co-production of health care. Therefore, a precise and context-sensitive definition of the term “health care user”, supported by a re-evaluation of politics for users in the modern health care system, seems indispensable.