Embed Size (px)
DESCRIPTION
Financing and fiscal sustainability: Achilles‘ heel of the German health system?. Markus Schneider (BASYS). Questions?. How sustainable is the German health system? Is financing via contributions a reason for concern? What are measures to increase fiscal sustainability?. - PowerPoint PPT Presentation
Citation preview
[email protected] Bad Hofgastein 27 September 2002 Page 1
Financing and fiscal sustainability: Achilles‘ heel of the German health
system?
Markus Schneider (BASYS)
[email protected] Bad Hofgastein 27 September 2002 Page 2
Questions?
• How sustainable is the German health system?
• Is financing via contributions a reason for concern?
• What are measures to increase fiscal sustainability?
[email protected] Bad Hofgastein 27 September 2002 Page 3
Health Expenditure as % of the GDP
1,05 1,31 1,35 1,39 1,53 1,51
1,031,17 1,27 1,36 1,29 1,340,26
0,54 0,57 0,600,93 0,99
0,57
1,04 1,00 0,880,91 0,87
1,92
2,89 2,99 3,16
3,34 3,09
0,27
0,460,58
0,69
0,89 1,08
0,79
0,960,99
1,05
1,43 1,37
0,00
2,00
4,00
6,00
8,00
10,00
12,00
1970 1977 1983 1989 1995 2000
other
dependency care
hospital care
dental care
medical aids
pharmaceuticals
physicians
West-Germany
[email protected] Bad Hofgastein 27 September 2002 Page 4
Annual Growth Rates(West-Germany)
1995-2000 1977-2000
physicians' outpatient services 2,6 5,4
pharmaceuticals 3,6 5,4
medical aids 4,1 7,6
dental care 1,9 4,0
hospital care 1,3 5,1
dependency care 6,9 8,8
other 2,0 6,4
total health expenditures 2,7 5,7
BIP 2,8 4,8
[email protected] Bad Hofgastein 27 September 2002 Page 5
Financing of THE as % of GDP(West Germany)
5,00 5,09 5,076,01 5,78
3,36 3,66 4,06
4,31 4,47
0,00
2,00
4,00
6,00
8,00
10,00
12,00
1 2 3 4 5
GKV Others
[email protected] Bad Hofgastein 27 September 2002 Page 6
Average contribution rate of GKV (%)
11,411,8
12,5
13,6 1414,1 13,913,5
6
8
10
12
14
16
1980 1985 1990 1995 1998 2002
West East
[email protected] Bad Hofgastein 27 September 2002 Page 7
Willingness to pay contribution
sacifrice benefits
19%
increase contributions
71%
do not know10%
Source: WidO 2002
[email protected] Bad Hofgastein 27 September 2002 Page 8
„Shunts“
Period Cumulated Financial Burden Mrd. €
Reduction of contribution base for unemployed in training: Pension Reform Law 1992
1995-2003 17,51
Increase of contributions from sickness benefits: Pension Reform Law 1992
1995-2002 4,89
Reduction of contribution base for beneficiaries with unemployed assistance: Law for Nonrecurring Payments 2000
2001-2003 1,83
Others 1995-2003 5,38
Total 1995-2003 29,61
Source: Beske 2002.
[email protected] Bad Hofgastein 27 September 2002 Page 9
Cost-control
• Bulit-in-Stabilizer• Pharmaceuticals• Integration• Health Centers• Disease Management• Prevention• Choice of Gate-keeping
[email protected] Bad Hofgastein 27 September 2002 Page 10
Conclusions
• Financing via contributions is not the Achilles‘ heel of the German health system
• Institutional restrictions, which limit selective contracting, vertical and horizontal integration, and the choice of tarifs in the statutory system, are rather the Achilles‘ heel of the German health system
