Economic behaviour as leitmotiv in health policy in Germany and its consequences for prevention and health promotion.
Since the mid 1970s the health policy in Germany has focused on cost containment - precisely reduction of employer's contribution for statutory health insurance (SHI). However political parties and the government have also changed their strategies to achieve this aim. The grown structures of SHI concerned with financing, provision and management remained unaltered till the early 90 s. The 90 s are marked by a broad transformation of the health sector. Regulatory instruments have been developed to create financial incentives for all stakeholders (sickness funds, health care providers, insured/patients) to reduce expenditure in health sector. The transformation process is marked by normative principle of taking stakeholders as economic subjects acting rationally. The article aims at evaluating the desired/undesired impacts of this paradigm shift, where solidarity is surpassed by competition, co-payment and privatisation. It shows where this paradigm change can be observed and which instruments have been used for its realisation. It is also given an analysis on the reaction of important stakeholders to this change. Finally, it is demonstrated ,by using examples of prevention and health promotion that the only focus on economic models doesn t allow health policy to adequately meet the challenges set upon it.
Stegmüller
Klaus
K
Department Nursing and Health Sciences, University of Applied Sciences Fulda, Fulda. stegmueller@hs-fulda.de
D001519:Behavior; D003695:Delivery of Health Care; D005858:Germany; D006291:Health Policy / Q000191:economics*; D006293:Health Promotion; D011315:Preventive Medicine