Kirchberger S
Landesversicherungsanstalt Sachsen LVA, Leipzig, Germany.
Health Policy. 1994 Oct-Dec;30(1-3):163-205. doi: 10.1016/0168-8510(94)00687-a.
The basic goal of the German health care system is equal access to all medical services for all citizens. The federal government sets the legal framework for the system, but most health policy decisions are made through bargaining between large organizations within a legal framework. The federal government took little active role in health care until the early 1990s, when it became increasingly apparent that budgeting and other cost containment measures seemed to be insufficient to successfully reduce the growth of mandatory sickness funds expenditures. A 1993 law has attempted to address some of the most obvious deficiencies in the system, while encouraging a market-oriented approach to health care. Health care technology assessment has almost no role in the German health care system. Attempts by professionals and politicians to introduce technology assessment into the health care arena have been largely unsuccessful.
德国医疗保健系统的基本目标是让所有公民都能平等地获得所有医疗服务。联邦政府为该系统设定法律框架，但大多数医疗政策决策是在法律框架内由大型组织之间通过协商做出的。直到20世纪90年代初，联邦政府在医疗保健方面几乎没有发挥积极作用，当时越来越明显的是，预算编制和其他成本控制措施似乎不足以成功降低法定疾病基金支出的增长。1993年的一项法律试图解决该系统中一些最明显的缺陷，同时鼓励采取以市场为导向的医疗保健方式。医疗技术评估在德国医疗保健系统中几乎没有作用。专业人士和政治家将技术评估引入医疗保健领域的尝试基本上没有成功。
