Gesundheitsreform: Ende der Krise oder Krise ohne Ende?

The German Statutory Health Insurance System (Gesetzliche Krankenversicherung) has been in a continuous reform process for the past twenty years. Therefore this economic policy forum is assigned to the question: Health reform: End of the crisis or never-ending crisis? Eckhard Knappe and Stefan Horter argue that this reform process was mostly dominated by the model of a cost-containment policy. Most health economists are not in favour of a global cost-containment policy, because it cannot solve the structural deficiencies within the system. As a result they recommend a further strategy of deregulation so that competitive processes will be enforced. Moreover Knappe and Horter show that this in turn will be more responsive to the preferences of the insured and patients and sets incentives for insurers and health-providers to follow efficiency goals in a static and dynamic way in order to mitigate the future burden of the demographic changes. Karl W. Lauterbach, Stephanie Stock and Thomas Evers determinate the thesis that medical innovation and future demographic changes will lead to increased prevalence of chronic diseases and thus to a strong increase of health expenditures are well established, putting the health care system into a permanent financial crisis. This article demonstrates that such a crisis will not necessarily occur in Germany. There is evidence that prevention measures and disease management programs can induce significant cost savings for highly prevalent chronic diseases like diabetes mellitus, colon-carcinoma, ischemic heart diseases, and cerebrovascular diseases. The cost savings could result from delayed onset of chronic disease (due to prevention) and fewer complications (due to disease management) for such diseases. 20% of all health care costs are caused by 20% of the insured, mostly due to chronic disease. Despite these implications, a final conclusion about the future health expenditures cannot be drawn.Switzerland often conceives of itself as a special case, and with regard to health care, it may well be one determines Peter Zweifel. In his article he argues that individuals have free individual choice of social health insurers and can express their preferences in the public domain rather directly, while competition in health care is fostered both by the new Law on Health Insurance of 1994 (LHI 94) and the new Law on Cartels of 1996. He discusses the objectives of the players involved in the promulgation of the LHI 94 and points out its inherent contradictions. Furthermore, Zweifel concludes by sketching additional future reforms that hold the promise of serving the objectives of insureds and patients by improving the ratio of expected benefits to cost in Swiss health care.