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German health care system Germany’s health insurance serves as model for social health insurance projects world wide. In fact, as institution the social health insurance has been surprisingly successful and resilient over time – it celebrated its 125^th birthday in 2008. The system has its problems and since the early 1990s a wave of progressively more fundamental reforms was enacted. A less well known fact is that Germany also has a private health insurance sector which covers about 10 percent of the population. The private system is fundamentally different from the social health insurance in aspects from financing to quality, and covers mostly civil servants and high-income earners. That system was also affected by the recent round of reforms. Up-to-date literature on the German health care system is somewhat rare, especially with regards to details. The recent reforms have changed fundamental elements of the system and so far I have not found a good summary of them all, in either German or English. Below some useful background, comments welcome. Recent reforms Brandt, N (2008) „Moving Towards more Sustainable Healthcare Financing in Germany“ OECD Economics Department Working Paper #612 http://puck.sourceoecd.org/vl=1610822/cl=16/nw=1/rpsv/workingpapers/18151973/wp_5kzlhmgrsqzx.htm · Concise technical overview of the recent reforms Reinhardt, UE and Cheng, TM (2008) „Shepherding Major Health System Reforms: A Conversation With German Health Minister Ulla Schmidt“ Health Affairs 27(3): w204-w213 http://content.healthaffairs.org/cgi/content/abstract/hlthaff.27.3.w204v1 · Good overview of politics and strategy of the recent health reforms · See accompanying letters for a discussion whether Germany could serve as model for the US Background on the system Busse, R and Riesberg, A (2004) „Health Systems in Transition: Germany“ http://www.euro.who.int/Document/E85472.pdf · Still the most comprehensive report that I’ve seen, though a little dated (a 2005 version is available in German only) · Briefly discusses the earlier reforms up to 2004 Empirical research Schreyögg, J and Grabka, M (2009) “Copayments for Ambulatory Care in Germany: a Natural Experiment Using a Difference-In-Difference Approach“ European Journal of Health Economics, online http://www.springerlink.com/content/ut5121252871u291/ · Also available as DIW discussion paper on http://www.diw.de/documents/publikationen/73/81490/dp777.pdf · One of the few focused empirical studies on German health reforms, using the SOEP data Last updated November 1, 2009