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GMG, Kopfpauschalen und Bürgerversicherungen: Der aktuelle Reformstand und seine intergenerativen Verteilungswirkungen

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  • Hagist, Christian
  • Fetzer, Stefan
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    Abstract

    Mit dem GKV-Modernisierungsgesetz sollte die GKV-Ausgabenseite auf ein langfristig stabiles Fundament gestellt werden. Für die langfristige Sicherung der GKV-Finanzierungsseite gibt es hauptsächlich zwei alternative Reformkonzepte, nämlich Bürgerversicherungs- und Kopfpauschalenmodelle. Der vorliegende Beitrag zeigt mittels der Methodik der Generationenbilanzierung, dass es durch das GKV-Modernisierungsgesetz nur unzureichend gelungen ist, die GKV nachhaltig zu reformieren. Konkrete Bürgerversicherungs- und Kopfpauschalenmodelle werden im vorliegenden Beitrag vergleichend systematisiert und analysiert. Es zeigt sich, dass sämtliche Vorschläge zusammen mit dem Modernisierungsgesetz das Ziel einer umfassenden nachhaltigen Finanzierbarkeit der GKV verfehlen. Zudem werden die reforminduzierten intergenerativen Verteilungswirkungen aufgezeigt. -- The new law ?GKV-Modernisierungsgesetz? was introduced in 2003 to stabilize the expenditures of the German public health sector in a long-term perspective. In addition, there are two alternative reform proposals, ?Kopfpauschalen? and ?Bürgerversicherung? to secure the financing of the public health sector in the long run. Using a generational accounting approach we find out that the ?GKVModernisierungsgesetz? is insufficient in creating a sustainable situation. To analyze the reform proposals ?Kopfpauschalen? and ?Bürgerversicherung? we give a structured comparison of current political commissions concepts. The analysis shows that also together with these concepts the new law fails sustainability. Furthermore we illustrate the intergenerational distribution effects induced by the discussed new law and the reform concepts.

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    Paper provided by Institut für Finanzwissenschaft, Albert-Ludwigs-Universität Freiburg in its series Discussion Papers with number 114.

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    Date of creation: 2004
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    Handle: RePEc:zbw:alufin:114

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    1. Alan J. Auerbach & Jagadeesh Gokhale & Laurence J. Kotlikoff, 1991. "Social Security and Medicare Policy From the Perspective of Generational Accounting," NBER Working Papers 3915, National Bureau of Economic Research, Inc.
    2. Alan J. Auerbach & Jagadeesh Gokhale & Laurence J. Kotlikoff, 1991. "Generational Accounts - A Meaningful Alternative to Deficit Accounting," NBER Working Papers 3589, National Bureau of Economic Research, Inc.
    3. Breyer, Friedrich & Haufler, Andreas, 2000. "Health Care Reform: Separating Insurance from Income Redistribution," Munich Reprints in Economics, University of Munich, Department of Economics 20114, University of Munich, Department of Economics.
    4. Bork, Christhart & Gasche, Martin, 2003. "Ökonomische Wirkungen einer Finanzierungsreform im Gesundheitswesen," Wirtschaftsdienst – Zeitschrift für Wirtschaftspolitik (1998 - 2007), ZBW – German National Library of Economics / Leibniz Information Centre for Economics, vol. 83(12), pages 768-776.
    5. Mathias Kifmann & Achim Wambach & Berthold U. Wigger, 2003. "Die Vorschläge der Kommission zur Finanzierung der Gesetzlichen Krankenkassen: Bürgerversicherung oder Kopfprämien?," Ifo Schnelldienst, Ifo Institute for Economic Research at the University of Munich, vol. 56(10), pages 3-10, 05.
    6. Matthias Wrede, 2002. "Freiwillige Versicherung in einer mit Pauschalbeiträgen finanzierten GKV: Ein Kommentar zu einem Vorschlag des Sachverständigenrats," Ifo Schnelldienst, Ifo Institute for Economic Research at the University of Munich, vol. 55(24), pages 17-21, December.
    7. Anita B. Pfaff & Martin Pfaff & Axel Olaf Kern & Bernhard Langer, 2003. "Kopfpauschalen zur Finanzierung der Krankenversicherungsleistungen in Deutschland," Discussion Paper Series, Universitaet Augsburg, Institute for Economics 246, Universitaet Augsburg, Institute for Economics.
    8. Friedrich Breyer & Volker Ulrich, 2000. "Gesundheitsausgaben, Alter und medizinischer Fortschritt: Eine Regressionsanalyse," Journal of Economics and Statistics (Jahrbuecher fuer Nationaloekonomie und Statistik), Justus-Liebig University Giessen, Department of Statistics and Economics, Justus-Liebig University Giessen, Department of Statistics and Economics, vol. 220(1), pages 1-17.
    9. Fetzer, Stefan & Moog, Stefan & Raffelhüschen, Bernd, 2003. "Die Nachhaltigkeit der gesetzlichen Kranken- und Pflegeversicherung: Diagnose und Therapie," Discussion Papers, Institut für Finanzwissenschaft, Albert-Ludwigs-Universität Freiburg 106, Institut für Finanzwissenschaft, Albert-Ludwigs-Universität Freiburg.
    10. Cristophe Borgmann & Pascal Krimmer & Bernd Raffelhüshen, 2001. "Rentenreformen 1998-2001: Eine (vorläufige) Bestandsaufnahme," Perspektiven der Wirtschaftspolitik, Verein für Socialpolitik, Verein für Socialpolitik, vol. 2(3), pages 319-334, 08.
    11. Friedrich Breyer, 2003. "Einkommensbezogene versus pauschale GKV-Beiträge: eine Begriffsklärung," Discussion Papers of DIW Berlin 330, DIW Berlin, German Institute for Economic Research.
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    Cited by:
    1. Hagist, Christian & Klusen, Norbert & Plate, Andreas & Raffelhüschen, Bernd, 2005. "Social health insurance: The major driver of unsustainable fiscal policy?," FZG Discussion Papers, Research Center for Generational Contracts (FZG), University of Freiburg 1, Research Center for Generational Contracts (FZG), University of Freiburg.

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