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Abstract
Germany's health insurance system represents the archetype of the healthcare arrangement generally known as the "Bismarck model". Core elements of this model are the management of healthcare by self-governing corporatist bodies and the funding primarily by income-related contributions, not by taxes. The German health care system has been in a dynamic transformation process since the early 1990s. We currently have a situation where elements of different systems exist side by side. In this contribution we argue that this transformation has already robbed the core elements of the Bismarck system of a great deal of their importance, and that it must be expected that their significance will continue to decline as the reform process progresses.
Zusammenfassung
Deutschland repräsentiert bekanntlich den Archetyp jener Gesundheitssysteme, die gemeinhin als Bismarck-Modelle bezeichnet werden. Zu den Kernelementen dieses Modells zählen die Steuerung des Krankenversorgungssysteme auf dem Wege der Selbstverwaltung und die Finanzierung der Krankenversorgung primär über einkommensbezogene Versiche-rungsbeiträge, nicht über Steuern. Das deutsche Gesundheitssystem befindet sich seit der ersten Hälfte der 90er Jahre in einem dynamischen Wandlungsprozess. Zurzeit haben wir es mit einer Koexistenz unterschiedlicher Systemmerkmale zu tun. Wir vertreten in diesem Beitrag die These, dass im Zuge dieses Wandels die Kernelemente des Bismarck-Systems bereits erheblich an Bedeutung verloren haben und dass damit zu rechnen ist, dass sie in den weiteren Reformprozess weiter an Bedeutung verlieren werden.
1 Introduction
Germany's health insurance system represents the archetype of the health-care arrangement generally known as the "Bismarck model". In the decades following its establishment in 1883 it served as the model for numerous other states setting up and designing their own health systems. Nations in continental western and central Europe were first to follow the German example, later joined by countries in Asia and Latin America. Since the collapse of the communist bloc, elements of the German-style health insurance system have come to play an important role in many central and eastern European states. In international comparative research the Bismarck model is identified today as one of three or four classic types of health system (e.g. Wendt 2008). For all the differences of detail, health insurance systems are characterized by the following shared core elements:
- Healthcare is managed by self-governing corporatist bodies, where a distinction must be drawn between...