Schmitt Tugce, Haarmann Alexander, Shaikh Mujaheed
Hertie School, Berlin, Germany.
Department of International Health, Care and Public Health Research Institute - CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Health Econ Policy Law. 2023 Jan;18(1):14-31. doi: 10.1017/S1744133122000123. Epub 2022 Aug 2.
Health system governance has been receiving increasing attention in health system research since the 1980s. The contemporary challenges that the German health system is faced with are often closely linked to governance issues. Although Germany has the highest health expenditure as a share of Gross Domestic Product (GDP) in the European Union (EU), the spending on healthcare is out of proportion to the health outcomes of the population. The reason for this lies mainly in the complexity of the German health system which is hard to steer due to several administrative levels in the country and numerous policy actors to whom the decision-making power on healthcare provision is delegated. In this paper, we present the results of focus group discussions on governance and build upon the insights gained through the project of the Robert Bosch Foundation. Based on an internationally recognised health governance framework from the World Health Organization (WHO), experts who work in, on or for the German health system addressed health governance challenges. They provided evidence-based recommendations for the new legislative period (2021-2025) on transparency, accountability, participation, integrity and capacity of the German health system.
自20世纪80年代以来，卫生系统治理在卫生系统研究中受到越来越多的关注。德国卫生系统面临的当代挑战往往与治理问题密切相关。尽管德国的卫生支出占国内生产总值（GDP）的比例在欧盟（EU）中最高，但医疗保健支出与民众的健康结果不成比例。其原因主要在于德国卫生系统的复杂性，由于国内存在多个行政层级以及众多被赋予医疗保健提供决策权的政策行为体，该系统难以驾驭。在本文中，我们展示了关于治理的焦点小组讨论结果，并基于通过罗伯特·博世基金会项目获得的见解。基于世界卫生组织（WHO）国际认可的卫生治理框架，在德国卫生系统内部工作、从事相关工作或为其工作的专家探讨了卫生治理挑战。他们为新的立法时期（2021 - 2025年）就德国卫生系统的透明度、问责制、参与度、廉正性和能力提供了基于证据的建议。
