March 10th, 2012
Even after the 2010 reforms adopted in the statutory health insurance and drug fee, a structural reform that makes health care affordable and efficient in the long term, continued to export. But the chances for such a reform are bad, because duration of the campaign in German federalism, strong particular interests, and one in the sensitive area of health emotional debate lead to a major reform of a political “hot potato” remains.
Health care in Germany is excellent. More than 95 percent of the world envy us. The scope of eligible services in Germany is Europe's largest. How long will this still be the case, is questionable, because with the aging and declining population, the blessing of the medical-technical progress, the increase in chronic diseases and the growing demand for quality services, not least in the nursing field, increase spending for health care.
As yet none of the numerous reforms, the structural deficits of the health system has received long-term in the handle, health reform for long-term task: Since the founding of the Federal Republic, there were more than 80 laws, which held the Federal Ministry of Health the lead. 1977-2000 alone there were more than 46 laws, with more than 6,800 individual rules and regulations. And the current federal government exercises in Panta Rhei of ongoing reform efforts: To date, three laws adopted with the objectives of the savings on medicines and the financing of health insurance. Another is for the performance-based remuneration of doctors and the blanket coverage was just approved by the Cabinet.
With these reforms, the federal government limits instead of a large litter once more mainly on short-term spending restraint and the avoidance of contribution rate increases. However, she's gone with the additional contributions as a step towards a more income-related financing for health insurance. However, whether this one as in the coalition agreement called for the medium and long term guaranteed funding of the health system can be achieved is questionable.
To make the health system in the long term efficient and financially viable, and no one excluded from health care, should have a basic insurance for all citizens to be introduced, with freedom of choice for additional benefits. In this “real” citizens' insurance, the system should be income-based contributions replaced by a system of contributions which are independent of age, gender, medical history and income. In addition, exposure limits are set. The social balance would then be where he can best succeed: through the tax and transfer system. Health insurance contributions were cut off from the wages paid and the employer contribution. There should be freedom of choice of all insured persons between the various providers – whether they are public or private – exist. For all providers of “real” citizens' insurance would be to contract, so that could not be rejected as chronically ill patients by insurance companies. A higher proportion of funding would improve the demographic strength. With such a long-term structural reform could secure health care and social equity succeed together.