title: Key Aspects of a Sustainable Health Insurance System in Germany.
abstract: BACKGROUND
  The main goals of health-care systems are to improve the health of the population they serve, respond to people's legitimate expectations, and offer fair financing. As a result, the health system in Germany is subject to continuous adaption as well as public and political discussions about its design.
  
  
  OBJECTIVE
  This paper analyzes the key challenges for the German health-care system and the underlying factors driving these challenges. We aim to identify possible solutions to put the German health-care system in a better position to face these challenges.
  
  
  METHODS
  We utilize a broad array of methods to answer these questions, including a review of the published and grey literature on health-care planning in Germany, semi-structured interviews with stakeholders in the system, and an online questionnaire.
  
  
  RESULTS
  We find that the most urgent (and manageable) aspects that merit attention are holistic hospital planning, initiatives to increase (administrative) innovation in the health-care system, incentives to increase prevention, and approaches to increase analytical quality assurance.
  
  
  CONCLUSIONS
  We found that hospital planning, innovation, quality control, and prevention, are considered to be the topics most in need of attention in the German health system.
authors.affiliation: Institute of Banking, Finance, and Accounting, Leuphana University of Lueneburg, Scharnhorststr. 1, 21335, Lüneburg, Germany. pelster@leuphana.de.
authors.forename: Matthias
authors.identifier: http://orcid.org/0000-0001-5740-2420
authors.initials: M
authors.lastname: Pelster
authors.affiliation: Department of Work and Organizational Psychology, Faculty of Psychology, Ruhr-University Bochum, Universitätsstr. 150, 44780, Bochum, Germany.
authors.forename: Vera
authors.initials: V
authors.lastname: Hagemann
authors.affiliation: German Center for Neurodegenerative Diseases e. V. (DZNE), DZNE site Witten, Stockumer Str. 12, 58453, Witten, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Laporte Uribe
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D005260:Female; D005858:Germany; D006752:Hospital Planning / Q000592:standards; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D020407:Internet; D007407:Interviews as Topic; D008297:Male; D020380:Needs Assessment; D011057:Politics; D015397:Program Evaluation / Q000191:economics; D011787:Quality of Health Care / Q000191:economics / Q000592:standards*; D019035:Rural Health Services / Q000592:standards; D011795:Surveys and Questionnaires; D019472:Universal Health Insurance / Q000191:economics / Q000458:organization & administration / Q000592:standards*