|Implemented in this survey?|
The health fund is currently the most favored proposal for health care financing reform. It is a compromise between the citizens insurance and the flat-rate health premiums scheme, favored by Social Democrats and Christian Democrats respectively. The health fund will draw on employee/employer contributions and on tax revenues. Sickness funds are to receive a flat-rate amount for each insured person out of this fund. Insurance of children will be financed through taxes.
The grand coalition's working group on health care reform discusses the health fund model (Gesundheitsfond) as part of a package of measures to secure the long-term financial
sustainability of the German health care system. An early version of the funding model was developed by the scientific advisory council of the Ministry of Finance in 2005 and promoted
by Volker Kauder, leader of the parliamentary group of the Christian Democratic Party. The model and its detailed design are hotly debated between and within the political parties and among
health experts, labor unions, sickness funds, etc.
The grand coalition is under pressure to develop a model for sustainable financing of the German health care system. It is estimated that in the first quarter of 2006, sickness funds incurred a deficit of €1.2 billion which is equivalent to about 3% of their expenditure. This deficit can be attributed to decreasing revenues (due to demographic change and high unemployment rates) and increasing expenditures (especially for inpatient care and pharmaceuticals).
Therefore the health fund, which combines aspects of the citizens insurance scheme and the flat-rate health premiums scheme, meets increasing acceptance from policy makers (for a description of these schemes refer to section "Origin of idea" and to survey (2)2003 "Proposals for SHI reform").
The envisioned health fund will draw on employer and employee contributions as well as on tax revenues. Contributions and tax revenues will flow directly into the health fund and will no longer be paid to health insurers.
Sickness funds and private health insurances will receive a flat rate of €150-170 out of the fund for each insured person and will be entitled to additional risk-adjusting payments if they insure many old or sick persons. Funds that operate efficiently may refund part of the contribution payments to their members or offer additional benefits. Excess costs may be covered by charging a nominal premium from their members (max. €40 per person).
The detailed design of the health fund is still under debate. Members of the working group have not yet agreed on important issues such as who should contribute to the health fund and how the employer contribution should be shaped (c.f. section "policy paper and stakeholder positions"). Therefore, the outcomes of this reform proposal are difficult to estimate at this point.
The insured, statutory sickness funds, private health insurers, tax payers, employers
|Medienpräsenz||sehr gering||sehr hoch|
In September 2005, a grand coalition of Christian Democrats and Social Democrats came into power. Facing urgent problems such as the high unemployment rate and the aging of the German society
(that lead to decreasing revenues for health insurance funds) and increasing health care expenditures, the government is under pressure to develop a sustainable financing mechanism for health
The coalition government paper stipulates
The aim of the government is to complete an outline containing cornerstones of its health care reform plan before the parliamentary summer break begins on July 8, 2006.
Social Democrats and Christian Democrats are forced to cooperate in the grand coalition. The health fund integrates the concepts of citizen?s insurance scheme, favored by the Social Democrats, and flat rate premiums, favored by the Christian Democrats.
Coalition paper of the grand coalition
|Implemented in this survey?|
The health fund model was developed by the scientific advisory council of the Ministry of Finance in 2005 and promoted by Volker Kauder, leader of the parliamentary group of the Christian
Democratic Party, in April 2006.
The main purpose of the health financing reform idea is to implement a sustainable financing mechanism for the German health care system. Facing increasing expenditures and decreasing revenues, the current system is not maintainable over the long run. The coalition parties seem to agree on the idea of a health fund as such but differ with respect to the detailed design of the new health fund and the focal points of the reform (c.f. section "policy paper and stakeholder positions").
The debate about the reform of the German health care system goes back many years. After the governing coalition of Social Democrats (SPD) and the Green Party (Bündnis 90/Die Grünen) had been confirmed in power in the general elections in 2002, the Minister of Health, Ulla Schmidt, had established a commission, the so-called Rürup Commission, with the task to develop a proposal on how to reform the German social security systems.
The commission developed two main reform proposals, aspects of which are now included in the health fund idea (for more detailed information on the two reform proposals c.f. survey (2)2003 "Proposals for SHI reform"):
Another reform proposal was developed by the Herzog Commission, which had been established by the then opposition party (Christian Democrats). This commission developed a proposal similar to the flat-rate premium proposal of the government commission. However, it combined flat-rate premiums with a capital stock to be built up through contributions by all insured and aimed at compensating individually for illness and aging.
The approach of the idea is described as:
The grand coalition, political parties, sickness funds, the scientific community, media and the public are divided over the reform proposal and its detailed design. The following issues are still controversially debated:
|Grand coalition||sehr unterstützend||stark dagegen|
|Statutory health insurers||sehr unterstützend||stark dagegen|
|Private health insurers||sehr unterstützend||stark dagegen|
|Unions||sehr unterstützend||stark dagegen|
|CDU / CSU||sehr unterstützend||stark dagegen|
|Left wing of the Social Democrats||sehr unterstützend||stark dagegen|
The grand coalition intends to submit an outline of health care system reform measures at the beginning of July. The reform proposal is highly controversial and the negotiation process is rather complicated. However, formal legislative changes will be required if the government decides to implement this reform.
|Grand coalition||sehr groß||kein|
|Statutory health insurers||sehr groß||kein|
|Private health insurers||sehr groß||kein|
|CDU / CSU||sehr groß||kein|
|Left wing of the Social Democrats||sehr groß||kein|
The actors involved in the adoption process will be the parliament, the Ministry of Health, statutory sickness funds as well as private health insurers, and the insured. However, it is still unclear if the health fund model will be accepted and how the detailed design will look like.
The envisaged effects and expected outcomes of the new financing mechanism are the following:
|Qualität||kaum Einfluss||starker Einfluss|
|Gerechtigkeit||System weniger gerecht||System gerechter|
|Kosteneffizienz||sehr gering||sehr hoch|
Weinbrenner, S., Busse, R. (2003): Proposals for SHI reform. Health Policy Monitor. Survey no (2)2003.
Zimmermann, Melanie; reviewers: Reinhard Busse, Sophia Schlette