The Self-Regulatory German Healthcare System Between Growing Competition and State Hierarchy

Abstract

Statutory Health Insurance is the central pillar of the German healthcare system. For many years, the German system operated predominantly on a self-regulatory basis, but since the early 1990s the self-regulatory German healthcare system has increasingly incorporated modes of co-ordination that are characteristic of other types of healthcare systems. Our main thesis states that both the role of the state and modes of co-ordination are changing in the direction of stronger market mechanisms and more direct state intervention while at the same time the principle of self-regulation is waning. In order to evaluate this thesis, our case study analyzes changes in healthcare financing, health service provision, and regulation in Germany from 1970 until today.