title: [Market Concentration in the Statutory Health Insurance of Germany since the Introduction of Free Choice of Sickness Funds].
abstract: Background:The expansion of trust law to the German statutory health insurance (SHI) and the declining numbers of sickness funds suggest a strong concentration process in the German SHI market. The paper examines the level and development of market concentration since the introduction of the free choice of sickness funds in 1996.Data:The study is based on a dataset containing information on membership, contribution rate, openness, area of activity and legal successor for all sickness funds in the period from 1996 to 2013.Methods:Market concentration is measured by the concentration rate (cumulative market share of the largest market participants) and the Herfindahl-Hirschman index (HHI). In addition, the change in the HHI is also disaggregated into 3 factors: opening, switching and fusion of sickness funds.Results:Concentration rate and HHI decreased significantly between 1996 and 2008 due to opening of former closed sickness funds and a switching behaviour from large to small funds. The SHI Competition Enhancement Act of 2007 led to a turnaround. The reform permitted cross-type mergers and introduced a completely new system of budget allocation with the central health fund. The latter put an end to the growing membership of small funds due to adverse selection processes. As a result, market concentration in the German SHI rises. Although recent mega-mergers were uncritical for nationwide competition, the study already indicates the risk of market dominance on the regional level.
authors.affiliation: "Staatlichkeit im Wandel", Universität Bremen, Sfb 597.
authors.forename: R
authors.initials: R
authors.lastname: Götze
mesh_terms: D004465:Economic Competition / Q000191:economics* / Q000706:statistics & numerical data; D005858:Germany; D018166:Health Care Reform / Q000191:economics*; D019981:Health Care Sector / Q000191:economics*; D015273:Insurance Selection Bias; D018868:Insurance, Disability / Q000191:economics* / Q000706:statistics & numerical data; D009313:National Health Programs / Q000191:economics*; D020403:Patient Freedom of Choice Laws / Q000191:economics*