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Die Nachhaltigkeit der gesetzlichen Kranken- und Pflegeversicherung: Diagnose und Therapie

Author

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  • Fetzer, Stefan
  • Moog, Stefan
  • Raffelhüschen, Bernd

Abstract

Im Folgenden sollen die Konsequenzen des demographischen Wandels für die Nachhaltigkeit der gesetzlichen Kranken- und Pflegeversicherung mit Hilfe der Generationenbilanzierung und anhand ergänzender Beitragssatzprojektionen auf derzeitiger Gesetzesgrundlage quantifiziert werden. Ausgehend von der Diagnose des gesetzlichen Status quo soll dann aufgezeigt werden, ob und inwieweit spezifische Reformmaßnahmen eine echte Therapie darstellen und somit zukünftig mehr Nachhaltigkeit in der gesetzlichen Kranken und Pflegeversicherung generieren könnten. Im Ergebnis zeigt sich, dass für die Strukturreform der gesetzlichen Krankenversicherung (GKV) ein schlichtes Jetzt oder Nie gilt, will heißen: Aus einer Kombination von mehr Wettbewerb im stationären Sektor, absoluten Selbstbehalten in der ambulanten und medikamentösen Versorgung und der Privatisierung von zahnärztlichen Leistungen, der sogenannten Freiburger Agenda, kann wieder eine Nachhaltigkeit in das System getragen werden. Aus dem Selbstbedienungsladen heutiger zu Lasten zukünftiger Generationen könnte so wieder ein echter Generationenvertrag werden. Anders hingegen im Fall der gesetzlichen Pflegeversicherung (GPV). Sie war entgegen der ursprünglichen (Blüm’schen) Intention noch nie ein Generationenvertrag1 und sie kann angesichts der demographischen Entwicklung auch nicht nachhaltig reformiert werden. Einzig mögliche Handlungsalternative ist schlicht die sukzessive Abschaffung der Pflegeversicherung. Beide Gesundheitssysteme sollen im Folgenden nacheinander analysiert werden.

Suggested Citation

  • Fetzer, Stefan & Moog, Stefan & Raffelhüschen, Bernd, 2003. "Die Nachhaltigkeit der gesetzlichen Kranken- und Pflegeversicherung: Diagnose und Therapie," Discussion Papers 106, Albert-Ludwigs-Universität Freiburg, Institut für Finanzwissenschaft.
    • Handle: RePEc:zbw:alufin:106
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    References listed on IDEAS

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    1. Jurgen Jerger & Jochen Michaelis, 1999. "Profit Sharing, Capital Formation and the NAIRU," Scandinavian Journal of Economics, Wiley Blackwell, vol. 101(2), pages 257-275, June.
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    8. Holger Bonin & Bernd Raffelhüschen & Jan Walliser, 2000. "Can Immigration Alleviate the Demographic Burden?," FinanzArchiv: Public Finance Analysis, Mohr Siebeck, Tübingen, vol. 57(1), pages 1-21, September.
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    Cited by:

    1. Fehr, Hans & Habermann, Christian, 2006. "Pension reform and demographic uncertainty: the case of Germany," Journal of Pension Economics and Finance, Cambridge University Press, vol. 5(1), pages 69-90, March.
    2. Adam Hans, 2007. "Einkommenswachstum, steigende Gesundheitsausgaben und Finanzierung / Income Increase, Health Spending Growth and Financing," Journal of Economics and Statistics (Jahrbuecher fuer Nationaloekonomie und Statistik), De Gruyter, vol. 227(5-6), pages 565-577, October.
    3. Noll Bernd & Wolf Sascha, 2019. "Altersrationierung im Gesundheitswesen – ein wirtschaftsethisch vertretbarer Weg?," Journal for Markets and Ethics, Sciendo, vol. 7(1), pages 1-20, June.
    4. repec:ces:ifodic:v:8:y:2010:i:2:p:14566976 is not listed on IDEAS
    5. Raffelhüschen, Bernd & Schoder, Jörg, 2005. "Möglichkeiten und Grenzen der Integration von genossenschaftlichem Wohnen in die Freiburger Zwei-Flanken-Strategie," Arbeitspapiere 50, University of Münster, Institute for Cooperatives.
    6. Melanie Arntz & Stephan L. Thomsen, 2010. "The Social Long-term Care Insurance: A Frail Pillar of the German Social Insurance System," ifo DICE Report, ifo Institute - Leibniz Institute for Economic Research at the University of Munich, vol. 8(2), pages 29-34, 07.
    7. Spermann, Alexander & Arntz, Melanie, 2003. "Wie lässt sich die gesetzliche Pflegeversicherung mit Hilfe personengebundener Budgets reformieren?," ZEW Discussion Papers 03-58, ZEW - Leibniz Centre for European Economic Research.
    8. Häcker, Jasmin & Hackmann, Tobias & Raffelhüschen, Bernd, 2010. "Pflegereform 2010: Karenzzeiten in der Sozialen Pflegeversicherung," FZG Discussion Papers 46, University of Freiburg, Research Center for Generational Contracts (FZG).
    9. Melanie Arntz & Stephan L. Thomsen, 2010. "The Social Long-term Care Insurance: A Frail Pillar of the German Social Insurance System," ifo DICE Report, ifo Institute - Leibniz Institute for Economic Research at the University of Munich, vol. 8(02), pages 29-34, July.
    10. Breyer, Friedrich & Franz, Wolfgang & Homburg, Stefan & Schnabel, Reinhold & Wille, Eberhard, 2004. "Reform der sozialen Sicherung: Kurzfassung," EconStor Books, ZBW - Leibniz Information Centre for Economics, number 92399, December.
    11. Christine Arentz & Ines Läufer & Steffen Roth, 2011. "Reform der gesetzlichen Pflegeversicherung: Teilkapitaldeckungsmodelle im Vergleich," Otto-Wolff-Institut Discussion Paper Series 04/2011, Otto-Wolff-Institut für Wirtschaftsordnung, Köln, Deutschland.
    12. Hagist, Christian & Fetzer, Stefan, 2004. "GMG, Kopfpauschalen und Bürgerversicherungen: Der aktuelle Reformstand und seine intergenerativen Verteilungswirkungen," Discussion Papers 114, Albert-Ludwigs-Universität Freiburg, Institut für Finanzwissenschaft.

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