Steering the Healthcare Ship: Effects of Market Incentives to Control Costs in Selected OECD Countries

A noticeable worldwide trend in the development of health systems is their increasing orientation towards the market and a dwindling influence on the part of the State. The so‐called health market is thus regarded in the same way as a market for vegetables or cars, over which the laws of supply and demand hold sway. The State can therefore maintain its influence through, among other things, behavioural incentives, whose function in market terms corresponds in many ways to that of tax reductions used to attain specific goals. Behaviour incentives are accordingly being used in numerous health systems to influence the behaviour of the market players, especially patients, sickness funds, doctors and pharmaceutical suppliers, through the establishment of financial gains or penalties. Percentage excesses, structures for competition between sickness funds, various kinds of fees for doctors or other behaviour incentives are frequently put in place as an instrument to hold down costs. Are market incentives really suitable, however, for example to influence medical decisions in such a way that costs can be kept under control? In the following article the cost control incentives most frequently encountered in OECD countries are set out and analysed as to their goals and effects.