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Finanzierungsreform und Risikostrukturausgleich - Was bleibt vom Ausgleichsverfahren?

  • Dirk Goepffarth


    (Bundesversicherungsamt, Bonn)

  • Klaus-Dirk Henke


    (Technische Universitaet Berlin)

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    In Germany, there is an ongoing debate on how to finance the statutory health insurance (SHI). Proposals include a "civic insurance" with a contribution rate drawn on a broader base and capitated payments. This debate will not subside with the recently issued white paper on health care reform, since fundamental issues were left open. This article does not develop a further variant of the discussed models. Instead, the components of which the future finance reform will have to consist are isolated and discussed with regard to their influence on the risk adjustment (RSA) scheme. The discussed topics are the differences between contribution rates and capitated payments, funded vs. pay-as-you-go systems, the question of whom to include in the statutory health insurance and central vs. decentralised collection of payments. This new perspective does not only allow conclusion on how the RSA scheme ought to be constructed in the future, it can also be shown which role the scheme has as framework for competition and for a possibly partially funded health insurance system.

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    Article provided by Justus-Liebig University Giessen, Department of Statistics and Economics in its journal Journal of Economics and Statistics.

    Volume (Year): 227 (2007)
    Issue (Month): 1 (February)
    Pages: 27-48

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    Handle: RePEc:jns:jbstat:v:227:y:2007:i:1:p:27-48
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    1. Wolfgang Buchholz, 2005. "A Note on Financing Health-Care Reform: Some Simple Arguments Concerning Marginal Tax Burden," FinanzArchiv: Public Finance Analysis, Mohr Siebeck, Tübingen, vol. 61(3), pages 438-, November.
    2. Robert Nuscheler & Thomas Knaus, 2005. "Risk selection in the German public health insurance system," Health Economics, John Wiley & Sons, Ltd., vol. 14(12), pages 1253-1271.
    3. Friedrich Breyer & Mathias Kifmann, 2001. "Optionen der Weiterentwicklung des Risikostrukturausgleichs in der GKV," Discussion Papers of DIW Berlin 236, DIW Berlin, German Institute for Economic Research.
    4. Wolfgang Buchholz & Birgit Edener & Markus Grabka & Klaus-Dirk Henke & Monika Huber & Hermann Ribhegge & Andreas Ryll & Hans-Jürgen Wagener & Gert G. Wagner, 2001. "Wettbewerb aller Krankenversicherungen kann Qualität verbessern und Kosten des Gesundheitswesens senken," Discussion Papers of DIW Berlin 247, DIW Berlin, German Institute for Economic Research.
    5. Hans Fehr & Heinrich Jess, 2006. "Health premiums or health contributions? An evaluation of health care reform options in Germany," Schmollers Jahrbuch : Journal of Applied Social Science Studies / Zeitschrift für Wirtschafts- und Sozialwissenschaften, Duncker & Humblot, Berlin, vol. 126(1), pages 20-57.
    6. Andreas Haufler, 2004. "Welche Vorteile bringt eine Pauschalprämie für die Finanzierung des Gesundheitswesens?," Schmollers Jahrbuch : Journal of Applied Social Science Studies / Zeitschrift für Wirtschafts- und Sozialwissenschaften, Duncker & Humblot, Berlin, vol. 124(4), pages 539-556.
    7. Richter, Wolfram F., 2005. "Gesundheitsprämie oder Bürgerversicherung? Ein Kompromissvorschlag," Wirtschaftsdienst – Zeitschrift für Wirtschaftspolitik (1998 - 2007), ZBW – German National Library of Economics / Leibniz Information Centre for Economics, vol. 85(11), pages 693-697.
    8. Klaus-Dirk Henke, 2005. "Was ist uns die Gesundheit wert? Probleme der nächsten Gesundheitsreformen und ihre Lösungsansätze," Perspektiven der Wirtschaftspolitik, Verein für Socialpolitik, vol. 6(1), pages 95-111, 02.
    9. Lamers, Leida M. & van Vliet, Rene C. J. A. & van de Ven, Wynand P. M. M., 2003. "Risk adjusted premium subsidies and risk sharing: key elements of the competitive sickness fund market in the Netherlands," Health Policy, Elsevier, vol. 65(1), pages 49-62, July.
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