Graf von der Schulenburg J M
FB Wirtschaftswissenschaften, Institut für Versicherüngsbetriebslehre, Hannover, Germany.
Soc Sci Med. 1994 Nov;39(10):1473-81. doi: 10.1016/0277-9536(94)90241-0.
Germany is known for its comprehensive health care coverage by sickness funds and private health insurers and its successful cost containment policy. The stabilization of health care expenditures as a percentage of GNP was enforced by five cost containment laws since 1977. The last one became effective in 1993 and the next ones are planned for 1996 and 2000. The 1993 law has initiated drastic changes of the system. Office based physicians will be paid by a mixture of capitation, fee-for-service and fees for combined service packages. The hospital financing will be transformed from the current per diem remuneration to a payment system where per diems are combined with payments based on diagnostic related groups and patient management categories. Up till now many restrictions exist for insurees to switch sickness funds. These limitations were removed by the 1993 law. To allow unbiased competition between sickness funds, a risk compensation pool, some kind of statutory reinsurance, will transfer financial resources from sickness funds with good risk structure to those with many bad risks. In many respects health policy has imposed what health economists have recommended for a long time. However, there is some doubt whether increased competition will really increase efficiency of providing medical care because it takes place in a highly regulated market.
德国以其疾病基金和私人健康保险公司提供的全面医疗保险覆盖范围以及成功的成本控制政策而闻名。自1977年以来，五项成本控制法律强制实现了医疗保健支出占国民生产总值百分比的稳定。最后一项法律于1993年生效，接下来的法律计划于1996年和2000年出台。1993年的法律引发了该体系的重大变革。以诊所为基础的医生将通过按人头付费、按服务收费和综合服务包收费相结合的方式获得报酬。医院融资将从目前的每日薪酬制转变为一种支付系统，即每日薪酬与基于诊断相关组和患者管理类别的支付相结合。到目前为止，被保险人更换疾病基金存在许多限制。1993年的法律取消了这些限制。为了使疾病基金之间能够进行公平竞争，一个风险补偿池，某种法定再保险，将把财政资源从风险结构良好的疾病基金转移到风险状况不佳的基金。在许多方面，卫生政策已经实施了卫生经济学家长期以来所建议的措施。然而，对于竞争加剧是否真的会提高医疗服务提供效率存在一些疑问，因为这是在一个高度监管的市场中发生的。
