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Analysing the impact of health-care system change in the EU member states - Germany


  • Markus Wörz

    (Department of Health Care Management, Berlin University of Technology, Germany)

  • Reinhard Busse

    (Department of Health Care Management, Berlin University of Technology, Germany)


The core of the German health-care system is the statutory health insurance (SHI). Coverage of the SHI has remained fairly constant at about 90% whereas the rest of the population is insured for the most part with private health insurance. The primary goal of health-care reforms since the 1990s has been to contain the expenditure of the SHI. The primary measures to do this have been the introduction of budgets and a shift of expenditure towards private households mainly in the form of benefit exclusions and increased co-payments. So far these measures did not have a negative effect on broad outcome measures such as life expectancy, which continued to rise, and self-assessed health of the population, which remained stable in the period 1992-2002. Besides cost containment another leitmotif of reform have been attempts to increase competition both between sickness funds and providers of care. These two strands of reforms also affected the incentive structures for both insurers and providers in various ways which this article describes. The immediate future of health-care reform will concern the mode of financing of the SHI which centres on the question if contributions proportional to income shall be maintained or if there shall be a radical shift towards flat-rate health premiums. Copyright © 2005 John Wiley & Sons, Ltd.

Suggested Citation

  • Markus Wörz & Reinhard Busse, 2005. "Analysing the impact of health-care system change in the EU member states - Germany," Health Economics, John Wiley & Sons, Ltd., vol. 14(S1), pages 133-149.
  • Handle: RePEc:wly:hlthec:v:14:y:2005:i:s1:p:s133-s149 DOI: 10.1002/hec.1032

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    References listed on IDEAS

    1. Gre[ss], Stefan & Groenewegen, Peter & Kerssens, Jan & Braun, Bernard & Wasem, Juergen, 2002. "Free choice of sickness funds in regulated competition: evidence from Germany and The Netherlands," Health Policy, Elsevier, vol. 60(3), pages 235-254, June.
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    8. Kamke, Kerstin, 1998. "The German health care system and health care reform," Health Policy, Elsevier, vol. 43(2), pages 171-194, February.
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    Cited by:

    1. Stock, Stephanie Anja Katharina & Redaelli, Marcus & Lauterbach, Karl Wilhelm, 2007. "Disease management and health care reforms in Germany--Does more competition lead to less solidarity?," Health Policy, Elsevier, vol. 80(1), pages 86-96, January.
    2. Göpffarth, Dirk & Henke, Klaus-Dirk, 2013. "The German Central Health Fund—Recent developments in health care financing in Germany," Health Policy, Elsevier, vol. 109(3), pages 246-252.
    3. José Castillo-Manzano & Mercedes Castro-Nuño & Xavier Fageda, 2014. "Can health public expenditure reduce the tragic consequences of road traffic accidents? The EU-27 experience," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 15(6), pages 645-652, July.
    4. Christian Bünnings & Harald Tauchmann, 2013. "Who Opts Out of the Statutory Health Insurance? A Discrete Time Hazard Model for Germany," Ruhr Economic Papers 0458, Rheinisch-Westfälisches Institut für Wirtschaftsforschung, Ruhr-Universität Bochum, Universität Dortmund, Universität Duisburg-Essen.
    5. Stock, Stephanie & Schmidt, Harald & Büscher, Guido & Gerber, Andreas & Drabik, Anna & Graf, Christian & Lüngen, Markus & Stollenwerk, Björn, 2010. "Financial incentives in the German Statutory Health Insurance: New findings, new questions," Health Policy, Elsevier, vol. 96(1), pages 51-56, June.
    6. Kristian Bolin & Anna Lindgren & Björn Lindgren & Petter Lundborg, 2009. "Utilisation of physician services in the 50+ population: the relative importance of individual versus institutional factors in 10 European countries," International Journal of Health Economics and Management, Springer, vol. 9(1), pages 83-112, March.
    7. Christian Bünnings & Harald Tauchmann, 2015. "Who Opts out of the Statutory Health Insurance? A Discrete Time Hazard Model for Germany," Health Economics, John Wiley & Sons, Ltd., vol. 24(10), pages 1331-1347, October.
    8. repec:spr:hecrev:v:7:y:2017:i:1:d:10.1186_s13561-017-0156-4 is not listed on IDEAS
    9. Härpfer, Marco & Cacace, Mirella & Rothgang, Heinz, 2009. "And fairness for all? Wie gerecht ist die Finanzierung im deutschen Gesundheitssystem? Eine Berechnung des Kakwani-Index auf Basis der EVS," Working papers of the ZeS 04/2009, University of Bremen, Centre for Social Policy Research (ZeS).
    10. Siegrist, Johannes & Shackelton, Rebecca & Link, Carol & Marceau, Lisa & von dem Knesebeck, Olaf & McKinlay, John, 2010. "Work stress of primary care physicians in the US, UK and German health care systems," Social Science & Medicine, Elsevier, vol. 71(2), pages 298-304, July.
    11. repec:zbw:rwirep:0458 is not listed on IDEAS

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