|Implemented in this survey?|
After the general German elections in 2002 the parties of CDU/CSU found themselves in opposition again. Reacting to the health sector crises former Minister of Health Horst Seehofer formulated an idea for reduction of premiums to secure the long-term delivery of high standard services and more responsibility for insured and patients. The idea seeks to contain costs for the health insurance by focusing on both the financing side as well as on the cost side.
Basic policy paper, written by Annette Widmann-Mauz and Andreas Storm, members of parliament
Blueprint for a health reform in Germany, with the following key elements:
The basic idea is cost containment for the health insurance in Germany. The focus is both on the financing side as well as on the cost side. The overall goal is to decrease expenditures, especially the financial burden for employers.
Employers by frozen financial contribution, which might affect their contribution in decision making processes, Dentists, because patients have to pay them on a private basis, Patients and insurees (see above), Low-income groups
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
After the general elections in 2002 the parties of CDU/CSU found themselves in opposition again. With the most important character for social policy issues, former Minister of Health Horst
Seehofer, recovering from a long lasting illness just slowly, it took a while for the CDU/CSU to formulate any idea for reacting to health sector crises. This policy paper seems to be a first step
back to sustainable health policy
The paper finds itself between many other papers (FES group, a group of scientists advising the social-democrats' party foundation and the Minister of Health and Social Security, Ulla Schmidt), ad-hoc commissions (Rürup Kommission, an advisory board on the future of social security systems installed and nominated by the Government, members are representatives of civil society, professional associations and academic institutions) and legal acts (SHI 2000 Act (Act to Strengthen Solidarity in Statutory Health Insurance)) and has to be seen as an attempt to influence the discussion.
|Implemented in this survey?|
The authors, Annette Widmann-Mauz and Andreas Storm
Driving forcesThe driving force behind is the need of the CDU/CSU to develop any fruitful concept for a reform after the loss in elections. Another driving force is the person of Horst Seehofer (see below)
Earlier discussionsThe paper connects quite often with earlier discussions, both within and outside the party. It contains statements plans to centralising health policy, referring to the idea of the MoHS to establish a German Center for Quality in Medicine, but besides that does not deal with quality issues at all.
More interesting is the reference to the Swiss system, which has been favoured by many CDU/CSU members, including Horst Seehofer. The paper points out that a Swiss like system with individual premiums would lead to a significant raise in taxes (because of hardship provision), plus overall costs will not be influenced positively. This is an important turn-around in the overall direction of the party's policy approach, even though the idea of more deductibles is well known and supported in earlier papers (see Horst Seehofer/Wolfgang Lohmann, Red-Green Health Policy - Balance of failure, Berlin, March 7th 2002).
There was support from the employers side, too.
Some of the ideas of the paper found their way to infiltrate a Gvt Declaration of chancellor Gerhard Schröder on March, 14th , 2003. Some members of the Rürup Commission also strongly favoured some of the thoughts, particularly the exclusion of dental care from benefit package. Whether they did so because of the paper or because of other reasons is hard to say. In fact, the support of stronger (financial) responsibility for patients by Gerd Schröder is not really a traditional Social Democrats position.
It is hard to say who is in the lead when reforming the health system in Germany these days. From a legal point of view it is the MoHS, but obviously the chancellor's office has strong stakes in the issue, too. The instalment of the Rürup Commission - and appointment of its members - was strongly influenced by that side. But for many substantial changes in legislation have to pass the Bundesrat, where the CDU/CSU has the majority of seats, the paper discussed here may well have a strong influence on the upcoming reforms.
Unexpected / undesirable effects
The main argument against excluding dental care from SHI coverage is equity: Social (financial) status will be visible through the quality of one's teeth. Because of that the SPD withdrew a similar approach enacted by the former government in 1998.
With many other services the link between prevention and health status is not as obvious or proven. To exclude them would mean to have a high chance of decreasing health status. Moreover, it is a highly contentious political issue whether to touch in upon all but a few cases - and the latter would not relieve health insurance sustainably.
Basic policy paper, written by Annette Widmann-Mauz and Andreas Storm, members of parliament.