Privatization, Liberalization, Re-Regulation:Recent Trends in German Health Policy

Johann Wolfgang Goethe-University Frankfurt

Institute of Medical Sociology

14th Conference of the International Association of Health Policy Europe (IAHPE)

Thessaloniki, 25th to 29th May 2005

Prof. Dr. Dr. Thomas Gerlinger

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Contents

1. German health policy in the 1990s

2. The law on the modernization of the compulsory health insurance system (2004)

3. Future trends

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German Health Policy in the 1990s

Change of paradigmas

• introduction of elements of competition

• raising of co-payments

• first steps to liberalize the collective contract system

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Direction of Change

• privatization of costs

• modernization of supply and service structures

• liberalization of contractual relations (between social health insurance funds and doctors)

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Financing

• introduction of new co-payments

• raising of existing co-payments

• exclusion of certain benefits from the benefits catalogue

• financing of insurance contributions for certain benefits only by the insured

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Service Structure

• new incentives for the delivery of integrated care

• access of Medical Service Centers to outpatient care

• new obligations to deliver care centered on general practitioners

• Institute for Quality and Efficiency in Health Care

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Regulation

• further liberalization of contractual relations (between social health insurance funds and doctors)

• further weakening of the collective contract system (with this remaining important)

• expectation: creation of a quality-centered competition

• extension of legal provisions for quality assurance

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Future Trends

• further privatization (especially under a conservative-liberal government)

• further liberalization an competition (especially under a red-green government)