Bernard Braun (Universitat Bremen)
Jens-Uwe Niehoff (Altwustrow)
The German Health Services System under transformation
The political languages still demands reforms. But the German health services system is going to transform into a different one. There are three main aspects of that transformation to identify:
- the transformation of financing the funds
- the transformation of the services to achieve and
- the transformation of the organizational body.
This presentation focuses on the change of the organizational body, because it is that aspect, mostly clear at the moment. Interestingly the organizational transformation and is (at the moment) nearly not discussed in public, at least not understood in its long-run consequences.
This presentation hypothesizes the organizational changes as most important and triggering both the financing and the services within the next ten up to fifteen years.
The features of the change are the opportunity for sick funds to contract out-patient services provided by “health centres” and limiting the power of classical providers. Both these changes have been demands from the left since decades. But as analyse will show, the new regulations are neither left nor standing in the tradition of a sick fund to compensate social disadvantages.
What are the points:
- Germany is going to install a Centre of Quality in Medicine as a the central body to guideline the norms and the rules of the systems achievements for the insured and to rule both the sick funds and the providers. This centre will replace the historical grown self-governed system with its shared power by the sick funds and the elected representatives of the doctors, called the corporatistic system.
- Germany is going to introduce health centres for ambulant care, but not to concentrate or to gather or to net the highly specialized medicine in out-patient facilities. This centres will contain mostly the family doctors, while the others will be contracted by the sick funds directly. That is aiming towards the use of the hospitals for ambulant care. That is clearly shifting the power from the providers to the customers.
- Germany is going to change the legal nature of the sick funds. The result will lead towards shifting the market power to the funds and to the integration of sick funds and there own providers. While the providers are shifting from not- profit to for-profit organizations, this development is going to integrate for-profit providers and sick funds both by contracts and by shared investments. Therefore sick funds are developing features of “true” companies.
The transformation will be the result of a mixture of deregulation policies, managed competition and a German kind of Managed Care and exactly that is its aim.
International Association of Health Policy 