Ulrich V, Wille E
Department of Economics, University of Mannheim, Germany.
Pharmacoeconomics. 1996;10 Suppl 2:81-8. doi: 10.2165/00019053-199600102-00013.
Germany is in a period of transition with regard to healthcare reform. The number and intensity of cost control interventions increased during the last decade in an attempt to contain healthcare expenditure. The German legislature has implemented long term macroeconomic measures such as contribution rate stability and global budgeting. The mid-term goal is to reduce the structural deficits of the current system. This paper argues that reference prices, introduced in the 1989 Healthcare Reform Act, did not produce the expected savings. An analysis of the effects of the 1993 Healthcare Structure Act on pharmaceutical expenditure is also presented. Compared with the implementation of the reference price system, the introduction of global budgeting in 1993 has had a more effective and lasting cost-containment impact. The paper concludes with a review of the main aspects of the current reform discussion.
德国在医疗改革方面正处于一个过渡时期。在过去十年里，成本控制干预措施的数量和力度不断增加，旨在控制医疗支出。德国立法机构已实施了诸如贡献率稳定和总额预算等长期宏观经济措施。中期目标是减少当前体系的结构性赤字。本文认为，1989年《医疗改革法案》引入的参考价格并未产生预期的节省效果。本文还对1993年《医疗结构法案》对药品支出的影响进行了分析。与参考价格体系的实施相比，1993年引入的总额预算对成本控制产生了更有效和持久的影响。本文最后对当前改革讨论的主要方面进行了回顾。
