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Towards sustainable health care systems: Strategies in health insurance schemes in France, Germany, Japan and the Netherlands ; a comparative study


  • Henke, Klaus-Dirk
  • Schreyögg, Jonas


In all four countries health care expenditures grow while the revenue remains at the same level or even shrinks in many cases. Due to medical progress, ageing and many other factors the gap is widening over time. The pay-as-you-go approach is running against limits either with rising employer and employee contribution rates as is the case in the so-called Bismarck-Systems or with higher taxes in the so-called Beveridge-systems. There are differences regarding the solutions of each country to tackle the described challenge and they might be able to learn from each other if they are compared. Therefore the study compares the health care systems of France, Germany, Japan and the Netherlands. Due to the complexity of the different institutional settings it seems necessary to select certain criteria in order to make a comparison at all possible. The comparison is divided into three different sections. The institutional and organizational framework as first section compares the general organization of social health insurance in all four countries. It comprises the benefit structure, the enrolment, ownership issues and other criteria. The second section focuses on the funding of social health insurance comparing the different approaches according to criteria like contribution rates, contribution assessment bases, burden of contributions and others. The final section analyses different strategies in the provision and purchasing of health services in the four countries. Next to other hospital ownership infrastructure characteristics play an important role in this section. In the last part of the study certain lessons are drawn from the comparison of the four countries. Furthermore certain developments are described which can be anticipated for the future of social health insurance systems.

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  • Henke, Klaus-Dirk & Schreyögg, Jonas, 2004. "Towards sustainable health care systems: Strategies in health insurance schemes in France, Germany, Japan and the Netherlands ; a comparative study," Discussion Papers 2004/9, Technische Universität Berlin, School of Economics and Management.
  • Handle: RePEc:zbw:tubsem:20049

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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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    Cited by:

    1. Wendt, Claus & Rothgang, Heinz, 2007. "Gesundheitssystemtypen im Vergleich: konzeptionelle Überlegungen zur vergleichenden Analyse von Gesundheitssystemen," TranState Working Papers 61, University of Bremen, Collaborative Research Center 597: Transformations of the State.
    2. Henke, Klaus-Dirk, 2004. "Was ist uns die Gesundheit wert? Probleme der nächsten Gesundheitsreformen und ihre Lösungsansätze," Discussion Papers 2004/2, Technische Universität Berlin, School of Economics and Management.

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