Breyer Friedrich
University of Konstanz and DIW, Berlin, Germany.
Pharmacoeconomics. 2002;20 Suppl 3:87-94. doi: 10.2165/00019053-200220003-00009.
This paper distinguishes short- and long-term financing problems in social health insurance systems in Germany and other European countries. The first part focuses on recent healthcare reforms in Germany that are directed at short-term problems, in particular measures of cost containment in the pharmaceutical sector such as the introduction of a drug formulary and reforms in the system of risk adjustment to enhance competition between sickness funds. The second part discusses the likely effects of the aging of the population on the sustainability of present types of mandatory insurance coverage in Germany and possible reforms that could solve the problems. It is argued that the proposed distinction between basic and supplementary benefits requires a system of explicit rationing (e.g. by age), which determines the package of basic benefits several decades in advance.
本文区分了德国和其他欧洲国家社会医疗保险体系中的短期和长期融资问题。第一部分聚焦于德国近期针对短期问题的医疗改革，特别是制药部门的成本控制措施，如引入药品处方集以及风险调整体系改革，以增强疾病基金之间的竞争。第二部分讨论了人口老龄化对德国现行强制保险覆盖类型可持续性的可能影响以及可解决这些问题的潜在改革措施。有人认为，提议的基本福利和补充福利区分需要一个明确的配给制度（如按年龄），该制度需提前几十年确定基本福利套餐。
