Reinhard Busse|Miriam Blümel|Franz Knieps|Till Bärnighausen
Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition
Berliner Hochschule für Technik|European Observatory on Health Systems and Policies|Berliner Hochschule für Technik|European Observatory on Health Systems and Policies|Harvard Global Health Institute|Heidelberg University|Africa Health Research Institute
bismarcks health insurance act 1883 established first social health insurance system world german statutory health insurance system built defining principles solidarity selfgovernance principles remained core continuous development 135 years gradual expansion population benefits coverage led 2017 universal health coverage generous benefits package selfgovernance initially applied mainly payers sickness funds extended 1913 cover relations sickness funds doctors turn led right insured individuals freely choose healthcare providers 1993 freedom choose ones sickness fund formally introduced reforms encourage competition strengthened market orientation gradually gained importance past 25 years reforms designed implemented protect principles solidarity selfgovernance 2004 selfgovernance strengthened establishment federal joint committee major payerprovider structure given task defining uniform rules access distribution health care benefits coverage coordination care across sectors quality efficiency oversight federal joint committee payer provider associations ensured good access highquality health care without substantial shortages waiting times selfgovernance however led oversupply pharmaceutical products excess number inpatient cases hospital stays problems delivering continuity care across sectoral boundaries german health insurance system costeffective germanys neighbouring countries given present expenditure levels indicates need improve efficiency value patients