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How to Finance Social Health Insurance: Issues in the German Reform Debate

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  • Friedrich Breyer

    (University of Konstanz and DIW, Berlin)

Abstract
In view of the rapidly rising contribution rates in the Statutory Health Insurance system and the persistently high unemployment rate, Germany has recently debated radical changes in the mode of health care financing. Among the controversial reform proposals were the possible expansion of mandatory membership to the whole population and the uncoupling of health insurance contributions from wage income. The main arguments in the German debate are presented and discussed. It is shown that there are valid welfare-economic reasons both for universal coverage and income-independent contributions. Moreover, it is demonstrated that the efficiency gains implicit in a transition to flat-rate contributions can be achieved in a distributionally neutral way if the measure is combined with an appropriate reform of the income tax system. Finally, it is shown that the replacement of pay-as-you-go financing by funding within social health insurance, while seemingly increasing the sustainability of the system, may create important additional problems. The Geneva Papers on Risk and Insurance (2004) 29, 679–688. doi:10.1111/j.1468-0440.2004.00310.x

Suggested Citation

  • Friedrich Breyer, 2004. "How to Finance Social Health Insurance: Issues in the German Reform Debate," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 29(4), pages 679-688, October.
    • Handle: RePEc:pal:gpprii:v:29:y:2004:i:4:p:679-688
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    References listed on IDEAS

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    1. Friedrich Breyer & Andreas Haufler, 2000. "Health Care Reform: Separating Insurance from Income Redistribution," International Tax and Public Finance, Springer;International Institute of Public Finance, vol. 7(4), pages 445-461, August.
    2. Florian Baumann & Volker Meier & Martin Werding, 2008. "Transferable Ageing Provisions in Individual Health Insurance Contracts," German Economic Review, Verein für Socialpolitik, vol. 9(3), pages 287-311, August.
    3. Friedrich Breyer, 2003. "Einkommensbezogene versus pauschale GKV-Beiträge: eine Begriffsklärung," Discussion Papers of DIW Berlin 330, DIW Berlin, German Institute for Economic Research.
    4. Kifmann, Mathias, 2002. "Insuring Premium Risk in Competitive Health Insurance Markets," Beiträge zur Finanzwissenschaft, Mohr Siebeck, Tübingen, edition 1, volume 15, number urn:isbn:9783161477409, May.
    5. Homburg, Stefan, 2000. "Compulsory savings in the welfare state," Journal of Public Economics, Elsevier, vol. 77(2), pages 233-239, August.
    6. Breyer, Friedrich & Franz, Wolfgang & Homburg, Stefan & Schnabel, Reinhold & Wille, Eberhard, 2004. "Reform der sozialen Sicherung: Kurzfassung," EconStor Books, ZBW - Leibniz Information Centre for Economics, number 92399, August.
    7. Cochrane, John H, 1995. "Time-Consistent Health Insurance," Journal of Political Economy, University of Chicago Press, vol. 103(3), pages 445-473, June.
    8. Blomquist, Soren & Christiansen, Vidar, 1998. "Topping Up or Opting Out? The Optimal Design of Public Provision Schemes," International Economic Review, Department of Economics, University of Pennsylvania and Osaka University Institute of Social and Economic Research Association, vol. 39(2), pages 399-411, May.
    9. Jean-Charles Rochet, 1991. "Incentives, Redistribution and Social Insurance," The Geneva Risk and Insurance Review, Palgrave Macmillan;International Association for the Study of Insurance Economics (The Geneva Association), vol. 16(2), pages 143-165, December.
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    Cited by:

    1. Christine Arentz & Johann Eekhoff & Susanna Kochskämper, 2012. "Private health insurance: a role model for European health systems," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 13(5), pages 615-621, October.
    2. Susanna Kochskämper, 2012. "Reformdebatten in der Krankenversicherung vor dem Hintergrund des europäischen Binnenmarktes," Otto-Wolff-Institut Discussion Paper Series 02/2012, Otto-Wolff-Institut für Wirtschaftsordnung, Köln, Deutschland.
    3. Kathrin Roll & Tom Stargardt & Jonas Schreyögg, 2012. "Effect of Type of Insurance and Income on Waiting Time for Outpatient Care," The Geneva Papers on Risk and Insurance - Issues and Practice, Palgrave Macmillan;The Geneva Association, vol. 37(4), pages 609-632, October.
    4. Annette Hofmann & Mark Browne, 2013. "One-sided commitment in dynamic insurance contracts: Evidence from private health insurance in Germany," Journal of Risk and Uncertainty, Springer, vol. 46(1), pages 81-112, February.
    5. Siadat, Banafsheh & Stolpe, Michael, 2005. "Reforming health care finance: What can Germany learn from other countries?," Kiel Economic Policy Papers 5, Kiel Institute for the World Economy (IfW Kiel).

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