German Federal Insurance Office, Bonn, Germany.
Health Policy. 2013 Mar;109(3):246-52. doi: 10.1016/j.healthpol.2012.11.001. Epub 2012 Nov 29.
In 2009, Germany's Statutory Health Insurance System underwent a major financing reform. A uniform contribution rate set by government was introduced. Sickness funds retain only limited autonomy in charging additional premiums. A dynamic subsidy from general revenue was introduced. The aims of the reform were: (1) intensifying competition, (2) gearing competition towards quality and efficiency, and (3) increasing financial sustainability. This article describes the reform, presents the experiences made, and evaluates whether the policy aims have been met. Experiences have been mixed: on the one hand, the new arrangement showed a high level of flexibility in dealing with the severe recession in 2009. On the other hand, the new system of price differentiation has proven to be dysfunctional. Payments to sickness funds are based on predictions. But predictions have been of limited accuracy, and this has led to an accumulation of liquidity in the system. Price competition has been effectively eliminated. The intended surge in quality and product competition failed to appear, as sickness funds remain concerned mainly with their short term financial outlook. SHI finance has become more linked to the federal budget, leading to a higher level of political interventions. These arrangements will need a new reform - probably after the next general election in autumn 2013.
2009 年，德国法定健康保险制度经历了一次重大的融资改革。政府引入了统一的缴费率。医保基金在收取额外保费方面仅保留有限的自主权。引入了来自一般财政的动态补贴。改革的目标是：（1）加强竞争，（2）使竞争面向质量和效率，（3）提高财务可持续性。本文描述了改革，介绍了取得的经验，并评估了政策目标是否得到了实现。经验参差不齐：一方面，新安排在 2009 年严重衰退时表现出了很高的灵活性。另一方面，新的价格差异化系统被证明是功能失调的。向医保基金的支付是基于预测的。但预测的准确性有限，这导致了系统中流动性的积累。价格竞争已被有效消除。预期的质量和产品竞争的激增并未出现，因为医保基金仍主要关注其短期财务前景。法定健康保险融资与联邦预算的联系更加紧密，导致更多的政治干预。这些安排将需要进行新的改革——可能在 2013 年秋季下一次大选之后。
