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Policy Paper CDU/CSU

Country: 
Germany
Partner Institute: 
Bertelsmann Stiftung, Gütersloh
Survey no: 
(1)2003
Author(s): 
Jan Böcken
Health Policy Issues: 
Funding / Pooling, Benefit Basket, Responsiveness
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no yes no no no no

Abstract

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.

Purpose of health policy or idea

  • Reduction of premiums to secure the long-term delivery of high standard services.
  • More responsibility for insured and patients

Main points

Main objectives

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:

  1. Stabilising the financial contribution of employers to social health insurance
  2. Increase of deductibles (co-payments? Bin mir nicht sicher, ob das dasselbe ist; - habe selbst als englischsprachige Vorlage den HiT-Report / Observatory genommen) for patients, combined with hardship provision
  3. Removal of non-health benefits from the SHI benefit package, especially dental care

Characteristics

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.

Type of incentives

For patients/insured:

Financial:

  • Deductibles of about 150 to 300 Euro
  • Higher co-payments, out of pocket payments
  • Lower premiums

Non Financial:

More prevention

Groups affected

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

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Characteristics of this policy

Degree of Innovation traditional neutral innovative
Degree of Controversy consensual neutral highly controversial
Structural or Systemic Impact marginal rather fundamental fundamental
Public Visibility very low neutral very high
Transferability strongly system-dependent rather system-neutral system-neutral

Political and economic background

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.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no yes no no no no

Origins of health policy idea

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).

Stakeholder positions

Opponents:

  • The governing Social Democrats and especially the Green Party (junior coalition party) are basically against excluding dental services and raising deductibles. However, since they need the support of the CDU/CSU in the Bundesrat, the reaction was moderate
  • Patients rights organizations for the same reasons

Acceptance

  • The paper strongly influenced a paper of the board of the CDU/CSU parliamentary group that was published five days later (12 March 2003,). So there was strong support from within the party.

There was support from the employers side, too.

Influences in policy making and legislation

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.

Adoption and implementation

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.

Expected outcome

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.

References

Sources of Information

Basic policy paper, written by Annette Widmann-Mauz and Andreas Storm, members of parliament.

Author/s and/or contributors to this survey

Jan Böcken

Suggested citation for this online article

Jan Böcken. "Policy Paper CDU/CSU". Health Policy Monitor, September 2002. Available at http://www.hpm.org/survey/de/b1/1