Health reform 2010: Start of a systemic change?

In autumn this year reform legislation of the statutory health insurance system will be presented to the Bundestag and is scheduled to take effect on 1 January 2011. Philipp Rösler, Federal Health Minister, explains the reform steps and stresses that the reform signifies the start of a systemic change, since with a fixed percentage contribution rate and the further development of additional payments, the income-dependence of the health-care system will be reduced and transparent price signals will be given; the health-insurance funds will receive the autonomy with regard to contributions that they need to be more competitive. At the same time compensating social elements will be introduced to prevent untoward burdens. Jochen Pimpertz, Institute of the German Economy, Cologne, is not so optimistic. In his opinion, the reform model of the federal government is disappointing. Instead of a departure from income-dependent contribution-financing, at the start only the contribution rates will increase. With the increase in the contribution rate, which has already been decided, both the misdirected incentives as will as the misguided allocation will only be made greater in the wake of the contribution financing. >em>Friedrich Breyer, University, of Constance, also does not see the comprehensive reform of health-care financing that was announced in the coalition contract of October 2009. The legislation is mainly aimed at preventing the deficit in the health insurance system forecast for 2011. It will not bring more competition and more efficiency to the German health insurance system. Wolfgang Greiner, University of Bielefeld, sees a further need for reform: “As in past years, after the reform is before the next reform; health-reform policy-makers are well advised to confront the spending problem not by dirigiste interference with the price structure but by allowing the self-regulating, competitive processes to run their course.” Gebhard Kirchgässner, University of St. Gallen, criticizes among other things the increase in the employee contribution rate. This will not decouple health insurance premiums from wages but will lead to another increase in the gap between gross and net wages. The government’s goal of decoupling will thus not be achieved. What Jürgen Wasem, University of Duisburg, sees is “a mere cost containment instead of structural reforms”.