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Moving Towards more Sustainable Healthcare Financing in Germany

  • Nicola Brandt

The aim of the recent healthcare reform was to increase the sustainability of healthcare finances, by reducing its negative impact on employment and increasing cost-effectiveness via enhanced competition. Higher budget contributions will help decouple healthcare finances from labour income a bit, if and once they materialise. An improved risk adjustment between insurers could reduce incentives for risk selection, raising chances for competition to lead to more cost-effectiveness instead. However, the segmentation of the healthcare system in a private and a social insurance market will continue to pose equity and efficiency problems. Owing to its design, the price signal in the new financing system for social health insurance will be both weak and distorted and this will need to be corrected for competition to produce desired results. More freedom for contractual relations between insurers, healthcare providers and pharmaceutical companies could help to better reap the benefits of competition, but the government will need to watch the results closely and adjust framework conditions if needed. Pérenniser le financement des dépenses de santé en Allemagne La réforme récente du secteur de la santé vise à assurer un financement plus viable des dépenses de santé en réduisant leurs effets négatifs sur l’emploi et en améliorant leur efficacité économique grâce à une concurrence accrue. Si l’augmentation prévue des contributions budgétaires se matérialise, elle permettra un certain découplage entre le financement du secteur de la santé et les revenus du travail. Une meilleure répartition des risques entre les assureurs pourrait réduire la tendance à une sélection des risques, si bien que la concurrence pourrait en fait conduire à une plus grande efficacité économique. Cela étant, la segmentation du système de santé dans un marché où cohabitent assurance privée et assurance publique continuera de poser des problèmes d’équité et d’efficacité. Par sa conception même, le nouveau système de financement de l’assurance maladie publique limite et fausse les signaux transmis par les prix ; il faudra donc remédier à ce problème pour permettre à la concurrence de produire les résultats souhaités. Une plus grande liberté des relations contractuelles entre assureurs, prestataires de soins et laboratoires pharmaceutiques permettrait sans doute de tirer un meilleur parti de la concurrence, mais les autorités devront faire preuve de vigilance et adapter les conditions cadres le cas échéant.

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Paper provided by OECD Publishing in its series OECD Economics Department Working Papers with number 612.

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Date of creation: 15 May 2008
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Handle: RePEc:oec:ecoaaa:612-en
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