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Umverteilungseffekte in der Finanzierung von Gesundheitsleistungen / Redistribution Effects of Health Care Financing


  • Buchner Florian

    () (MPH, Professur für Gesundheitsökonomie an der Fachhochschule Kärnten, Standort Feldkirchen, Hauptplatz 12, A-9560 Feldkirchen, Austria)

  • Deppisch Rebecca

    () (Alfried Krupp von Bohlen und Halbach-Stiftungslehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Campus Essen, Universitätsstraße, 45127 Essen, Germany)

  • Wasem Jürgen

    () (Alfried Krupp von Bohlen und Halbach- Stiftungslehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Campus Essen, Universitätsstraße, 45127 Essen, Germany)


Health care systems are financed through a mixture of different components: taxes, contributions to social health insurance, premiums to private health insurance, out of pocket payments by patients. These components can be combined differently leading to specific effects of interpersonal redistribution. This can be compared between different countries. In such a comparison the redistributional impact of the German health care systems is rather regressive - which is basically caused by the opportunity for people with high income to leave social health insurance. In comparison to a health insurance system with risk rated premiums, financing of the German social health insurance leads to interpersonal redistribution from higher to lower income, from the young to the elderly, from healthy to sick and from singles to families with children. The pay-as-you-go character of the system leads especially in combination with an aging population and technological change to burden for future generations. In comparison to a system in which each region finances its own health care expenditures, there are also considerable interregional redistributions. The financing system in Germany is not conceptually consistent. Reform proposals (unified health insurance for all; flat rate premiums) tackle these inconsistencies.

Suggested Citation

  • Buchner Florian & Deppisch Rebecca & Wasem Jürgen, 2007. "Umverteilungseffekte in der Finanzierung von Gesundheitsleistungen / Redistribution Effects of Health Care Financing," Journal of Economics and Statistics (Jahrbuecher fuer Nationaloekonomie und Statistik), De Gruyter, vol. 227(5-6), pages 699-724, October.
  • Handle: RePEc:jns:jbstat:v:227:y:2007:i:5-6:p:699-724

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    References listed on IDEAS

    1. Markus Jankowski & Anne Zimmermann, 2004. "Die interpersonelle Umverteilung in der Gesetzlichen Krankenversicherung – Status Quo und Perspektiven der Ausgestaltung," Otto-Wolff-Institut Discussion Paper Series 04/2004, Otto-Wolff-Institut für Wirtschaftsordnung, Köln, Deutschland.
    2. Van de ven, Wynand P.M.M. & Ellis, Randall P., 2000. "Risk adjustment in competitive health plan markets," Handbook of Health Economics,in: A. J. Culyer & J. P. Newhouse (ed.), Handbook of Health Economics, edition 1, volume 1, chapter 14, pages 755-845 Elsevier.
    3. Zweifel, Peter & Breuer, Michael, 2006. "The case for risk-based premiums in public health insurance," Health Economics, Policy and Law, Cambridge University Press, vol. 1(02), pages 171-188, April.
    4. Wasem, Jürgen & Buchner, Florian & Lux, Gerald & Manouguian, Maral-Sonja & Schillo, Sonja, 2007. "Die Regionaldimension in der Gesetzlichen Krankenversicherung vor dem Hintergrund des GKV-WSG: Gutachten für das Land Baden-Württemberg," IBES Diskussionsbeiträge 153, University of Duisburg-Essen, Institute of Business and Economic Studie (IBES).
    5. Gert G. Wagner, 2003. "Pauschalprämien setzen das Konzept der Bürgerversicherung am besten um," ifo Schnelldienst, ifo Institute - Leibniz Institute for Economic Research at the University of Munich, vol. 56(17), pages 3-6, September.
    6. Wagstaff, Adam & van Doorslaer, Eddy, 1992. "Equity in the finance of health care: Some international comparisons," Journal of Health Economics, Elsevier, vol. 11(4), pages 361-387, December.
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    Cited by:

    1. Rausch, Johannes & Gasche, Martin, 2014. "Beitragssatzentwicklung in der Gesetzlichen Krankenversicherung und der Sozialen Pflegeversicherung - Projektionen und Determinanten," MEA discussion paper series 201404, Munich Center for the Economics of Aging (MEA) at the Max Planck Institute for Social Law and Social Policy.


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