1. ms@basys.deBad Hofgastein 27 September 2002 Page 1 Financing and fiscal sustainability: Achilles‘ heel of the German health system? Markus Schneider (BASYS)

2. ms@basys.deBad Hofgastein 27 September 2002 Page 2 Questions? How sustainable is the German health system? Is financing via contributions a reason for concern? What are measures to increase fiscal sustainability?

3. ms@basys.deBad Hofgastein 27 September 2002 Page 3 Health Expenditure as % of the GDP West-Germany

4. ms@basys.deBad Hofgastein 27 September 2002 Page 4 Annual Growth Rates (West-Germany)

5. ms@basys.deBad Hofgastein 27 September 2002 Page 5 Financing of THE as % of GDP (West Germany)

6. ms@basys.deBad Hofgastein 27 September 2002 Page 6 Average contribution rate of GKV (%)

7. ms@basys.deBad Hofgastein 27 September 2002 Page 7 Willingness to pay contribution Source: WidO 2002

8. ms@basys.deBad Hofgastein 27 September 2002 Page 8 „Shunts“

9. ms@basys.deBad Hofgastein 27 September 2002 Page 9 Cost-control Bulit-in-Stabilizer Pharmaceuticals Integration Health Centers Disease Management Prevention Choice of Gate-keeping

10. ms@basys.deBad Hofgastein 27 September 2002 Page 10 Conclusions Financing via contributions is not the Achilles‘ heel of the German health system Institutional restrictions, which limit selective contracting, vertical and horizontal integration, and the choice of tarifs in the statutory system, are rather the Achilles‘ heel of the German health system