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

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  • Lisac, Melanie
  • Reimers, Lutz
  • Henke, Klaus-Dirk
  • Schlette, Sophia

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.

Suggested Citation

  • Lisac, Melanie & Reimers, Lutz & Henke, Klaus-Dirk & Schlette, Sophia, 2010. "Access and choice – competition under the roof of solidarity in German health care: an analysis of health policy reforms since 2004," Health Economics, Policy and Law, Cambridge University Press, vol. 5(1), pages 31-52, January.
    • Handle: RePEc:cup:hecopl:v:5:y:2010:i:01:p:31-52_99
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    Cited by:

    1. Teris Cheung & Paul H Lee & Paul S F Yip, 2018. "The association between workplace violence and physicians’ and nurses’ job satisfaction in Macau," PLOS ONE, Public Library of Science, vol. 13(12), pages 1-20, December.
    2. Göpffarth, Dirk & Henke, Klaus-Dirk, 2013. "The German Central Health Fund—Recent developments in health care financing in Germany," Health Policy, Elsevier, vol. 109(3), pages 246-252.
    3. Becker, Christian & Holle, Rolf & Stollenwerk, Björn, 2015. "The excess health care costs of KardioPro, an integrated care program for coronary heart disease prevention," Health Policy, Elsevier, vol. 119(6), pages 778-786.
    4. Hossein, Zare & Gerard, Anderson, 2013. "Trends in cost sharing among selected high income countries—2000–2010," Health Policy, Elsevier, vol. 112(1), pages 35-44.
    5. Vomhof, Markus, 2016. "Hospital competition with heterogeneous patient groups: Incentives and regulation," Ruhr Economic Papers 624, RWI - Leibniz-Institut für Wirtschaftsforschung, Ruhr-University Bochum, TU Dortmund University, University of Duisburg-Essen.
    6. Johannes Stauder, 2019. "Unemployment, unemployment duration, and health: selection or causation?," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(1), pages 59-73, February.
    7. Buchner, Florian & Goepffarth, Dirk & Wasem, Juergen, 2013. "The new risk adjustment formula in Germany: Implementation and first experiences," Health Policy, Elsevier, vol. 109(3), pages 253-262.
    8. Joan Costa-i-Font & Valentina Zigante, 2014. "The Choice Agenda' in European Health Systems: The Role of 'Middle Class Demands," LEQS – LSE 'Europe in Question' Discussion Paper Series 82, European Institute, LSE.

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