Moving Towards more Sustainable Healthcare Financing in Germany

The aim of the recent healthcare reform was to increase the sustainability of healthcare finances, by reducing its negative impact on employment and increasing cost-effectiveness via enhanced competition. Higher budget contributions will help decouple healthcare finances from labour income a bit, if and once they materialise. An improved risk adjustment between insurers could reduce incentives for risk selection, raising chances for competition to lead to more cost-effectiveness instead. However, the segmentation of the healthcare system in a private and a social insurance market will continue to pose equity and efficiency problems. Owing to its design, the price signal in the new financing system for social health insurance will be both weak and distorted and this will need to be corrected for competition to produce desired results. More freedom for contractual relations between insurers, healthcare providers and pharmaceutical companies could help to better reap the benefits of competition, but the government will need to watch the results closely and adjust framework conditions if needed.