Academic journal article German Policy Studies

Health Policy and Marketization: Introduction

Academic journal article German Policy Studies

Health Policy and Marketization: Introduction

Article excerpt

The German health care system is undergoing a process of fundamental change in its regulatory structures. Hitherto, in spite of the variety of control over health care policy in Germany, corporatist forms of regulation have been particularly important. These corporatist structures have recently attracted a hail of criticism, being justifiably blamed for many lapses in quality and a good deal of inefficiency in the provision of medical care. Since the early 1990s elements of market regulation have incrementally gained in importance. Competition between statutory health insurance funds has been established by the introduction of free choice of sickness funds for the insured. Moreover, in recent years demands are growing louder for the competition between these funds to be complemented by competition between the health care providers. Essentially, the idea is to take the collective contracts between statutory health insurance funds and health insurance agencies and replace them with individual contracts, which are expected to improve quality and cut costs. This issue addresses the features of regulatory change in German health care policy and its effects on the system as a whole and on single sectors of care.

Gerlinger and Schmucker analyze the dynamic reform process of the "Bismarck model" since the early 1990s. They argue that core elements of the Bismarck system--self-governing corporatist decision-making and the predominant role of income-related contributions--become less important. Due to the fact that the German health care system already faces a situation where elements of different systems exist side by side, they expect that the significance of the Bismarck model will be on the wane.

Ewert focuses the changing role of health care users, which act to an increasing degree in different contexts as citizens, patients, consumers or community members. Based on a precise differentiation between marketization and economization, this article highlights challenges as well as possible odds and constraints of health care user participation.

Bandelow reveals the transformation of outpatient care in Germany and asks for the outcome of these changes. Against the background of changes in the legal framework and policy impacts concerning the system of organized interests, Bandelow evolves four ideal-typical scenarios of possible future governance modes in outpatient care. …

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