Levelling vs competition – political trend reversal in the German healthcare system?

• Published in: Ekonomski vjesnik Vol. 27; no. 2; pp. 463 - 471
• Main Authors: Wolf, Sascha, Amelung, Volker
• Format: Journal Article
• Language: English
• Published: Osijek Sveučilište Josipa Jurja Strossmayera u Osijeku, Ekonomski fakultet u Osijeku 01.12.2014; Josip Juraj Strossmayer University of Osijek, Faculty of Economics in Osijek; J.J. Strossmayer University of Osijek, Faculty of Economics
• Subjects: Competition; Councils; Federal funding; Health and medicine and law; Health care expenditures; Health care industry; Health care policy; Health insurance; National Economy; Political Theory; Politics; Studies; Sustainability; Germany; German healthcare system; Health Fund; integrated care; contract competition; innovation fund
• ISSN: 0353-359X; 1847-2206

For almost 20 years, the German federal government has declared that competition is the key to ensuring the financial sustainability of the healthcare system. The aim of this paper is to investigate if German government indeed has followed a direct path to enhancing competition. For this purpose, a qualitative analysis of the most important healthcare reform acts has been conducted. In conclusion, especially since the introduction of the Health Fund in 2009, a clear trend towards more levelling and regulation can be observed. This trend is confirmed by the most recent healthcare reform act in June 2014. The abolishment of flat-rate premiums is the expression of the government’s fear that competitive pressure could endanger the solvency and viability of sickness funds (statutory health insurance funds). In contrast, on the market for selective contracts, an ambivalent picture emerges. On the one hand, several possibilities for establishing new forms of healthcare and strengthening competition have been introduced. On the other hand, sickness funds as well as service providers are often reluctant to enter into selective contracts.