The German context

The Bertelsmann Stiftung holds a specific view of the German health policy environment: we intend to deepen the analysis of interaction of stakeholders and policy makers, and assist with the management of interests and relationships between different players in the health sector. This, in our opinion, is the key to health policy reform in our country.

In Germany, while access to health care is good, there is broad consensus about inefficiencies in the provision of services. Co-ordination gaps, lack of transparency, and a lack of valid and comparable information on cost and quality of services - have also been criticized nationally and internationally. The phenomenon became well-known when the results of a major review "Over-, Under-, and Misuse of the German Health Care System" were made public in 2001 by the  Advisory Council to the Concerted Action in Health Care.

On the other hand, the current debate is taking place in a rigid, much institutionalized setting and a highly complex, fragmented system of multiple payers, providers and politics. Quite obviously, none of these factors helps with the development of innovative approaches or blueprints for reform and reorganization. There are established mechanisms for political discussion and decision-making with vested interests and well-known positions. Debate goes on in circles so that new ideas are rarely generated and seriously considered. Although reform pressure increases with progress, cost and an inelastic demand for better services and therapies, there is little political will - or fear - to profoundly reform a system which for decades has too comfortably catered for many diverse interests.