Entwicklung der öffentlichen Gesundheitsausgaben
Götz Zeddies
Wirtschaftsdienst,
No. 6,
2023
Abstract
Die sozialen Sicherungssysteme in Deutschland basieren auf dem Umlageverfahren, bei dem die Ausgaben der Sozialversicherungen in der laufenden Periode durch Einnahmen aus Beiträgen, die auf die Einkommen der abhängig Beschäftigten erhoben werden, gedeckt werden. Vor dem Hintergrund des demografischen Wandels, der in den kommenden Jahren immer stärker zum Tragen kommen wird, wird häufig die Nachhaltigkeit der umlagefinanzierten sozialen Sicherungssysteme hinterfragt, weil sich das Verhältnis von Beitragszahlern und Leistungsempfängern ändern wird. Dies dürfte sich zwar vor allem bei der gesetzlichen Rentenversicherung auswirken, aber auch bei der gesetzlichen Kranken- und der Pflegeversicherung.
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19.04.2018 • 7/2018
Joint Economic Forecast Spring 2018: Germany’s Economic Experts Raise Forecast Slightly
Berlin, 19 April – Germany’s leading economic experts raised their forecasts for 2018 and 2019 slightly in their Spring Joint Economic Forecast released on Thursday in Berlin. They now expect economic growth of 2.2 percent for this year and 2.0 percent for 2019, versus 2.0 percent and 1.8 percent respectively in their autumn forecast. “The German economy is still booming, but the air is getting thinner as unused capacities are shrinking“, notes Timo Wollmershaeuser, ifo Head of Economic Forecasting. Commenting on the new German government’s economic policy, he adds: “It is precisely when the government’s coffers are full that fiscal policy should reflect the implications of its actions for overall economic stability and the sustainability of public finances. The extension of statutory pension benefits outlined in the coalition agreement runs counter to the idea of sustainability.”
Oliver Holtemöller
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Greater Efficiency through More Competition in the Health Care Sector?
Ingmar Kumpmann
WSI-Mitteilungen,
No. 4,
2012
Abstract
More competition among health insurers is often recommended as a means towards enhancing efficiency in the health care sector. In this paper the effects of competition among health insurers on costs and quality of medical services are discussed. It is argued that if insurers competed with each other, costs would not decrease - on the contrary, they would increase since competing organisations are less capable of counterbalancing the strong market position of health care providers than the state or a cartel of health insurers. In addition, competition may lead to a segmentation of the market: on the one hand insurers with low premiums who only offer access to rather unpopular physicians. On the other hand insurers who guarantee free choice of medical practitioners but have higher premiums. A restriction of the free choice of medical practitioners weakens competition among physicians for patients.
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Folgen des Wettbewerbs zwischen Krankenversicherungen für die Kosten im Gesundheitswesen
Ingmar Kumpmann
Gesundheitspolitik, Wettbewerb und Gesundheitssystemforschung. DIBOGS-Beiträge zur Gesundheitsökonomie und Sozialpolitik Bd. 3,
2009
Abstract
In this study it is argued that competition among health insurers can bring about higher costs in the health care sector. Medical services are inhomogeneous goods; thus the competition between physicians can be modeled by Chamberlins concept of monopolistic competition. The physicians have a strong bargaining power face to face a multitude of competing health insurers acting as purchasers of health care services. The costs can be lower if the physicians’ strong position is compensated by a monopolistic health insurer. Two case studies show the applicability of the argument. A regression analysis confirms the correlation between (public) monopolistic health insurer and lower costs in the health care sector.
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Modelle für die Zukunft der gesetzlichen Krankenversicherung
Ingmar Kumpmann
Kostenträger Entscheiderbrief 4/2009,
2009
Abstract
A discussion of different health insurance models and implications for the German health care system.
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Monopolistic Competition and Costs in the Health Care Sector
Ingmar Kumpmann
IWH Discussion Papers,
No. 17,
2009
Abstract
Competition among health insurers is widely considered to be a means of enhancing efficiency and containing costs in the health care system. In this paper, it is argued that this could be unsuccessful since health care providers hold a strong position on the market for health care services. Physicians exert a type of monopolistic power which can be described by Chamberlin’s model of monopolistic competition. If many health insurers compete with one another, they cannot counterbalance the strong bargaining position of the physicians. Thus, health care expenditure is higher, financing either extra profits for physicians or a higher number of them. In addition, health insurers do not have an incentive to contract selectively with health care providers as long as there are no price differences between physicians. A monopolistic health insurer is able to counterbalance the strong position of physicians and to achieve lower costs.
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In Search of the Best Solution – Four Models of Health Insurance
Ingmar Kumpmann
Wirtschaft im Wandel,
No. 11,
2008
Abstract
In this article, a classification of health insurance systems is proposed. Four ideal type models can be distinguished. The advantages and disadvantages of these models are discussed and empirically investigated. Health insurance systems with a high degree of monopoly and high participation of the state result in lower health care expenditures than systems with various competing health insurance funds. In systems with independent health insurance funds, patients do have more rights than in systems with directly state-driven health care services.
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Grenzen des Wettbewerbs im Gesundheitswesen
Ingmar Kumpmann
Sozialer Fortschritt,
2008
Abstract
Many health economists demand more competition in the health-care system. They focus on the competition between the individual health-insurance funds for those who want such insurance as well as on the competition between health-care providers for contracts with the health-insurance funds. However, they neglect the competition between health-care providers for patients; such competition is crucial for medical quality. This latter area of competition is in conflict with the two former ones. The empirical evidence on the effects of competition on cost and quality are also ambiguous. Thus, the mere appeal for „more competition“ does not do justice to the highly complex nature of the health-care system.
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Grenzen des Wettbewerbs im Gesundheitswesen
Ingmar Kumpmann
IWH Discussion Papers,
No. 1,
2008
Abstract
Many health economists demand more competition in the health care system. They focus on the competition between sickness funds for insured and the competition between health care providers for contracts with sickness funds. But they neglect the competition between health care providers for patients which is crucial for medical quality. This third field of competition is in conflict with the two former fields. The empirical evidence concerning the effects of competition on cost and quality is also ambiguous. Thus the mere claim for “more competition” does not do justice to the high complexity of the health care system.
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The coalition treaty from a fiscal point of view
Kristina vanDeuverden
Wirtschaft im Wandel,
No. 12,
2005
Abstract
After weeks of negotiations the coalition finally agreed on the conditions for their political work. Not surprisingly, the coalition agreement is complex and intransparent – with a multitude of single measures far away from a precise definition. Quantifying the programme and estimating resulting cash flows is currently difficult; official calculations are – if at all – only partly available. Anyhow, the contract will form the basis for economic policy during the next four years; therefore its evaluation by now is indispensable. The thin red line of the agreement – not astonishingly when considering the precarious financial situation of the public sector – is consolidation. However, more than 80% of the consolidation volume results from the revenue side. Though one third of this is due to the cutback of tax exemptions, the lion’s share comes from raising tax rates, mainly the VAT standard rate. In contrast, cutting back public expenditure is minor and the agreement clearly comes short of the Koch/Steinbrück proposal; even new tax reliefs are created. The consolidation is almost completely borne by private households. Enterprises as a whole are barely hit. However, they have to wait until 2008 for a reform of company taxation – one of the most pressing problems in this legislative period. To reduce the companies tax burden until the reform starts the conditions for tax depreciation are temporarily relaxed. Anyway, from an international point of view the statutory tax rate is an important signal to enterprises deciding where to invest. Lowering effective tax rates by changing depreciation conditions is intransparent and, thus, will be less effective. Furthermore savings within the public sector are planned to accomplish consolidation; 10 billion Euro should result from efficiency gains and reduced expenditure. Consolidation measures mainly focus on the budget of the federal government. However, Länder and communities will participate in the additional tax revenues. In contrast, social securities will loose – and therefore also the share of employment that is subject to social insurance contribution. Particularly the unemployment insurance will be burdened by the decrease of its premium rate. Besides, the federal government will reduce its grants to the pension funds and most notably the health system. The contract is dominated by fiscal constraints. Cyclical requirements are considered only cursory and pressing structural reforms are put off. The reforms of company’s taxation, of fiscal federalism, of the health system as well as a proceeding reform of the labour market are only proposed. How and when measures in these fields are realised will determine whether fiscal policy can set a new course.
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