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German voters unsure about health of the nation
POLICY AND PEOPLE FEATURE
German voters unsure about health of the nation nosis related groups aims to measure woman on the street doesn’t really s German voters go to the polls how much hospitals spend on treatknow how to solve this, nor which on Sept 22 health policy has been ing patients grouped by illnesses and party could actually solve it”, he adds. relatively low among voters’ concerns. then pay according to the number of The parties differ over which parts On the centre left, Chancellor patients treated per illness group of the health care service should be Gerhard Schroeder, leader of the rulrather than per hospital day. SPD exposed to competition to improve ing Social Democrat party (SPD), is maintains that measuring performquality without spending more standing for re-election. The SPD’s ance is needed to establish criteria money. About 90% of the population main problem has been unemployfor monitoring efficiency across are covered by statutory health insurment, which stands at about four milthe national health system lion and has changed little in and eventually standardisthe past 4 years. Schroeder ing practice throughout has promised a stronger Rights were not granted to include this Germany. economy and social justice image in electronic media. Please Meanwhile, the new disand his prompt response to refer to the printed journal. ease management prothe widespread floods in the grammes attempts to open region and his decision not to medical treatment to compesupport the war on Iraq were tition. This programme has popular. been opposed by doctors’ On the right, the opposigroups. The Federal tion Christian Democrat Association of Statutory Union/Christian Social Health Insurance Doctors Union (CDU/CSU) presidential candidate is Edmund Health policies of Edmund Stoiber (left) and Gerhard Schroeder have refused to sign the new contracts before the election. Stoiber, who is the Minister (right) are not that far apart The CDU/CSU argue that President of Bavaria who all the reforms encroach on doctors ance. Seven large associations of notpoints to the healthy Bavarian econprofessional autonomy and will for-profit insurance funds compete omy as an indicator of his abilities. He worsen patient care. for the public’s contributions. The said he would cut taxes, promote famWhereas the CDU/CSU reforms funds contract services from doctors’ ily values, and said that people must put the onus on patients, SPD policy associations and hospitals. rely less on the state to finance their pressures doctors to deliver improveThe opposition CDU/CSU advoold age. Stoiber criticised Schroeder’s ments. Beyond each partys’ attempts cates a more flexible system, giving stance on Iraq but has since refused to cut costs are more fundamental difhealth insurance funds and service to support US-led action outside ferences in their health policies. providers the autonomy to decide the UN. Underlying the CDU/CSU’s prowith whom to negotiate contracts. To While the broad domestic and forposed reforms is a deep-seated mismake competition truly effective they eign policies of the main opponents trust of centralised control and argue insurers must be able to vary have been relatively easy to distinregulation. “A socially just, progresthe treatment catalogue, allowing guish, their respective health policies sive health care system is not an end contributors to choose their level of have been very similar. “The high in itself—the patients themselves cover and to incur excess charges. “At quality of medical care must continue must be placed at the centre of every the heart of the CDU/CSU health to be affordable . . . competition activity”, says Seehofer. The SPD’s policy is the mature patient, responsiwithin the system will achieve this health Minister Ulla Schmidt ble for their own decisions and negogoal. Cost effectiveness will stabilise responds that in effect this will cause tiations . . . Experience from the contribution rates”, declares the SPD. the public health sector to contract as private insurance sector shows us that “More competition and flexibility . . . the young and the poor take out not only do excess charges serve to will help to raise the quality and cost insufficient cover. “Then when these reduce contributions but also make effectiveness of health care”, agrees people fall seriously ill, they will lose the insured take more care of their Horst Seehofer, the CDU/CSU extheir savings”, she adds. health”, argues Andreas Storm, health minister and current health The government has rejected CDU/CSU parliamentary health spokesman. This agreement reflects changes to the treatment catalogue working group member. “Only in this the fact that neither party when in and has instead proposed to increase way can our health system concengovernment was able to prevent the financing by expanding the public trate on the coverage of really significost of health care from rising. Earlier health system. The Green Party advocant risks . . . without placing this year contribution rates for health cates universal coverage while the excessive demands on the contribuinsurance were raised from 13·5% to SPD would increase by a third the tors”, he adds. 14%. monthly €3300 threshold above While paying lip-service to the need “People are really more concerned which wage earners can opt out of the for flexible contracts between the about worse benefits than slightly statutory health insurance system. insurance funds and doctors, the SPD increased costs. They have realised “Whether the border between statuprogramme centres on continuing that costs are increasing in health care tory and private health insurance reforms introduced over the past year. and they are more worried that the should be shifted is especially pertiTo counterbalance increasing drug quality might go down if too much nent in this electoral debate”, Busse expenditure the government brought pressure is put on the system”, comconcludes. in a measure that obliged chemists to ments Reinhard Busse, professor of dispense cheaper generic medicines. health care management, Technical The gradual introduction of diagUniversity, Berlin. “The man or Claudia Orellana AP
A
930
THE LANCET • Vol 360 • September 21, 2002 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.
German voters unsure about health of the nation nosis related groups aims to measure woman on the street doesn’t really s German voters go to the polls how much hospitals spend on treatknow how to solve this, nor which on Sept 22 health policy has been ing patients grouped by illnesses and party could actually solve it”, he adds. relatively low among voters’ concerns. then pay according to the number of The parties differ over which parts On the centre left, Chancellor patients treated per illness group of the health care service should be Gerhard Schroeder, leader of the rulrather than per hospital day. SPD exposed to competition to improve ing Social Democrat party (SPD), is maintains that measuring performquality without spending more standing for re-election. The SPD’s ance is needed to establish criteria money. About 90% of the population main problem has been unemployfor monitoring efficiency across are covered by statutory health insurment, which stands at about four milthe national health system lion and has changed little in and eventually standardisthe past 4 years. Schroeder ing practice throughout has promised a stronger Rights were not granted to include this Germany. economy and social justice image in electronic media. Please Meanwhile, the new disand his prompt response to refer to the printed journal. ease management prothe widespread floods in the grammes attempts to open region and his decision not to medical treatment to compesupport the war on Iraq were tition. This programme has popular. been opposed by doctors’ On the right, the opposigroups. The Federal tion Christian Democrat Association of Statutory Union/Christian Social Health Insurance Doctors Union (CDU/CSU) presidential candidate is Edmund Health policies of Edmund Stoiber (left) and Gerhard Schroeder have refused to sign the new contracts before the election. Stoiber, who is the Minister (right) are not that far apart The CDU/CSU argue that President of Bavaria who all the reforms encroach on doctors ance. Seven large associations of notpoints to the healthy Bavarian econprofessional autonomy and will for-profit insurance funds compete omy as an indicator of his abilities. He worsen patient care. for the public’s contributions. The said he would cut taxes, promote famWhereas the CDU/CSU reforms funds contract services from doctors’ ily values, and said that people must put the onus on patients, SPD policy associations and hospitals. rely less on the state to finance their pressures doctors to deliver improveThe opposition CDU/CSU advoold age. Stoiber criticised Schroeder’s ments. Beyond each partys’ attempts cates a more flexible system, giving stance on Iraq but has since refused to cut costs are more fundamental difhealth insurance funds and service to support US-led action outside ferences in their health policies. providers the autonomy to decide the UN. Underlying the CDU/CSU’s prowith whom to negotiate contracts. To While the broad domestic and forposed reforms is a deep-seated mismake competition truly effective they eign policies of the main opponents trust of centralised control and argue insurers must be able to vary have been relatively easy to distinregulation. “A socially just, progresthe treatment catalogue, allowing guish, their respective health policies sive health care system is not an end contributors to choose their level of have been very similar. “The high in itself—the patients themselves cover and to incur excess charges. “At quality of medical care must continue must be placed at the centre of every the heart of the CDU/CSU health to be affordable . . . competition activity”, says Seehofer. The SPD’s policy is the mature patient, responsiwithin the system will achieve this health Minister Ulla Schmidt ble for their own decisions and negogoal. Cost effectiveness will stabilise responds that in effect this will cause tiations . . . Experience from the contribution rates”, declares the SPD. the public health sector to contract as private insurance sector shows us that “More competition and flexibility . . . the young and the poor take out not only do excess charges serve to will help to raise the quality and cost insufficient cover. “Then when these reduce contributions but also make effectiveness of health care”, agrees people fall seriously ill, they will lose the insured take more care of their Horst Seehofer, the CDU/CSU extheir savings”, she adds. health”, argues Andreas Storm, health minister and current health The government has rejected CDU/CSU parliamentary health spokesman. This agreement reflects changes to the treatment catalogue working group member. “Only in this the fact that neither party when in and has instead proposed to increase way can our health system concengovernment was able to prevent the financing by expanding the public trate on the coverage of really significost of health care from rising. Earlier health system. The Green Party advocant risks . . . without placing this year contribution rates for health cates universal coverage while the excessive demands on the contribuinsurance were raised from 13·5% to SPD would increase by a third the tors”, he adds. 14%. monthly €3300 threshold above While paying lip-service to the need “People are really more concerned which wage earners can opt out of the for flexible contracts between the about worse benefits than slightly statutory health insurance system. insurance funds and doctors, the SPD increased costs. They have realised “Whether the border between statuprogramme centres on continuing that costs are increasing in health care tory and private health insurance reforms introduced over the past year. and they are more worried that the should be shifted is especially pertiTo counterbalance increasing drug quality might go down if too much nent in this electoral debate”, Busse expenditure the government brought pressure is put on the system”, comconcludes. in a measure that obliged chemists to ments Reinhard Busse, professor of dispense cheaper generic medicines. health care management, Technical The gradual introduction of diagUniversity, Berlin. “The man or Claudia Orellana AP
A
930
THE LANCET • Vol 360 • September 21, 2002 • www.thelancet.com
For personal use. Only reproduce with permission from The Lancet Publishing Group.