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Professional paper

Levelling vs competition – political trend reversal in the German healthcare system?

Sascha Wolf ; Pforzheim University, Business School, Pforzeim, Germany
Volker Amelung ; Hannover Medical School, Hannover, Germany

Full text: english pdf 152 Kb

page 463-471

downloads: 690



For almost 20 years, the German federal government has declared that competition is the key to ensuring
the financial sustainability of the healthcare system. The aim of this paper is to investigate if German
government indeed has followed a direct path to enhancing competition. For this purpose, a qualitative
analysis of the most important healthcare reform acts has been conducted. In conclusion, especially since
the introduction of the Health Fund in 2009, a clear trend towards more levelling and regulation can be observed.
This trend is confirmed by the most recent healthcare reform act in June 2014. The abolishment of
flat-rate premiums is the expression of the government’s fear that competitive pressure could endanger the
solvency and viability of sickness funds (statutory health insurance funds). In contrast, on the market for
selective contracts, an ambivalent picture emerges. On the one hand, several possibilities for establishing
new forms of healthcare and strengthening competition have been introduced. On the other hand, sickness
funds as well as service providers are often reluctant to enter into selective contracts.


German healthcare system, Health Fund, contract competition, integrated care, innovation fund

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