In international comparison, Germany ranks 4th among OECD countries in health expenditure as a share of GDP in 2011. It amounted 11.3% of GDP in 2011 which is 2%-points above the OECD average of 9.3%. Only the United States (17.7%), the Netherlands (11.9%) and France (11.6%) are spending more on health. In addition, German health expenditure increased, in real terms, at a rate of circa 2% p.a. on average in 2000-2010, but slowed down to 1.1% in 2011.
However, expenditure continues to grow. With regard to these figures, health care is one of the most important sectors in Germany. With more than 6 million employees and a gross value added of almost € 268 bn in 2013, it represents 11% of the German economy. While expenditure is on the rise, the number of contributors who finance the health care system decreases. As a result, the question of how to finance the growing demand for health services occurs.
In particular, a closer look at the statutory health insurance (SHI) is necessary as it financed 57% of total health expenditure in 2011. Since the report “Achieving financial sustainability for the social security systems” by the Rürup-Commission, two major reform proposals are discussed: the citizens' insurance (“Bürgerversicherung”), a universal system of health care, and a system of flat-rate health premiums (“pauschale Gesundheitsprämien”). These approaches are intensively discussed by politicians and economists who search for an appropriate solution for a health care reform.
Therefore, the following question should be answered by this seminar paper: Should we move to a universal, flat rate system? In order to develop an appropriate recommendation, the following questions appear:
How does the current health insurance system in Germany look like? Which problems does this system face? What contribution do the two reform proposals provide for a solution of these challenges? Which are the main arguments in favour and against these approaches? Are there any economic consequences of their implementation? What could be a final solution?
These questions will be responded in the following seminar paper.
Contents
II. List of abbreviations
III. List of figures
1. Introduction
2. Status quo of the German health care system
2.1 Set-up
2.2 Challenges
3. Universal system
3.1 Definition
3.2 Discussion
3.3 Economic impacts
4. Flat-rate system
4.1 Definition
4.2 Discussion
4.3 Economic impacts
5. Universal, flat rate system
6. Conclusion
IV. References
V. Appendix
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