Health Economics, Policy and Law

Table of Contents - - Volume 5, Issue 01  

Articles

Access and choice – competition under the roof of solidarity in German health care: an analysis of health policy reforms since 2004

Melanie Lisaca1, Lutz Reimersa2, Klaus-Dirk Henkea3 c1 and Sophia Schlettea4 c2

a1 Project Manager, International Network Health Policy & Reform, Bertelsmann Stiftung, Gütersloh, Germany

a2 Department of Public Finance and Health Economics, Technische Universität Berlin, Germany

a3 Professor of Public Finance and Health Economics, Technische Universität Berlin, Germany

a4 Senior Expert Health Policy, Bertelsmann Stiflung, Gütersloh, Germany, currently on a sabbatical as Senior International Adviser, Kaiser Permanente Institute for Health Policy, Oakland, CA, USA

Abstract

This paper analyses the influence of recent German health care reforms, the Statutory Health Insurance Modernization Act 2004 and the Statutory Health Insurance Competition Strengthening Act 2007, on different dimensions of access and choice. More specifically, we look at and discuss the effects of these policies on the availability, reachability and affordability of health care as well as on their impact on consumers’ choice of insurers and providers. Generally, patients in Germany enjoy a high degree of free access and a lot of freedom to choose, partly leading to over- and misuse of health services. Concerning choice of insurers, one result of our analysis is that in the statutory health insurance system, the introduction of a greater variety of benefit packages will develop into an additional parameter of choice. In contrast to that, insurees more and more accept certain restrictions of choice and direct access to providers by enrolling into new forms of care (such as gatekeeping-, disease management- and integrated care programmes). However, they might benefit from better quality of care and more options for products and services that best fit their needs.

Correspondence:

c1 Correspondence to: Sophia Schlette, Bertelsmann Stiftung, Gütersloh, Germany. Email: sophia.schlette@bertelsmann-stiftung.de, and

c2 Klaus-Dirk Henke, TU Berlin, at KHenke@finance.ww.tu-berlin.de