title: [Discussing a "two-tiered medical system": a statement].
abstract: The criticism of a "two-tiered medical system" is a political slogan, which is also not exactly defined. However, for the public discussion this is not of further importance because talking about a "two-tiered medical system" has a priori a negative impact; in particular in times when people's fears surrounding medical care in Germany are great. Especially in a public health insurance system, insured people worry that in the future they will only receive the most essential medical services, rather than all services that are deemed reasonable and medically appropriate. One of the central themes in the discussion of a "two-tiered medical system" that causes disputes (or animosity) between privately and publicly insured persons arises when comparing differences in waiting periods to see a doctor and additional medical treatments made available to the privately insured. Critics of the "two-tiered medical system" envision a "one-tiered medical system"; one in which every person receives uniform healthcare, and in which the "purchase" of additional medical treatments is not permitted. However, the "one-tiered medical system" remains a theoretical construct. Service differences based on price differences are the reality. So the problem of the "two-tiered medical system" manifests itself only when those services that go beyond the basic care (privately offered services) negatively impact basic care, and/or displace basic care offerings. An example of this would be when a publicly insured patient has to wait longer to see a doctor because preference is given to privately insured patients. Economically speaking, negative external effects come into play. This causality has not been found or proven to be present in the German healthcare system. It exists neither in the inpatient nor in the outpatient healthcare sector. There is no basis to the claim that there is a difference in treatment favouring private patients with detrimental effects to non-privately insured patients. Therefore the claim that a "two tiered medical system" exists is negated. On the contrary: In the German health care system treatment differences above and beyond the basic services lead to an advantage for publicly insured patients. There are no negative, but rather positive external effects. This is mainly attributed to the increased doctors' revenue in the outpatient sector which amounted to Euro 4.4 billion in 2006 alone. Therefore, private patients subsidise the public insurance by funding a disproportionately high share of doctors' budgets.
authors.forename: F Schulze
authors.initials: FS
authors.lastname: Ehring
authors.forename: Ch
authors.initials: Ch
authors.lastname: Weber
mesh_terms: D003258:Consumer Behavior; D005858:Germany; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D007342:Insurance Benefits / Q000592:standards*; D009313:National Health Programs / Q000592:standards*; D011057:Politics; D011787:Quality of Health Care / Q000592:standards*