Health reform divides German coalition governmentBMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7571.720-b (Published 05 October 2006) Cite this as: BMJ 2006;333:720
Germany's chancellor, Angela Merkel, has been struggling for weeks to reach an agreement on her ambitious health reform plans with her Social Democrat coalition partners, as well as the powerful state premiers from her own Christian Democrat party. She wants to reach a stable compromise by the end of October.
The health reform plan is aimed at reducing the German healthcare budget, the third highest in the world. Under the proposal healthcare insurance fees paid by employees and their employers will rise by around 0.5% by 2007.
And for the first time in the national health system's 150 year history tax revenues will be used to help finance the system (bmj.com, 15 Jul, News Extra).
From the start the compromise bill, drawn up by the coalition partners, drew severe criticism from politicians as well as doctors, hospitals, and representatives of the state health insurance funds and employers, and it has had to be revised and postponed once. It is now set to be finalised by the end of October and come into force by April 2007.
However, arguments over details have triggered speculation that the government coalition is falling apart before it is even a year old. Ms Merkel responded by saying that although problems continued there was an “absolute political will” within the coalition to reach agreement.
Points of contention between the coalition parties are the income linked cap on individual insurance premiums—favoured by the Social Democrats and their health minister, Ulla Schmidt—and provisions to shuffle funds between health insurance companies, as well as a large rise in insurance premiums for the country's 8.5 million privately insured patients, which are drawing protests from within Ms Merkel's party. The Social Democrats' leader, Kurt Beck, said the cap remained a “decisive point” for his party.
The health reform plans have been criticised by the German Medical Association, which called for a nationwide one day strike by doctors. On 22 September about 15 000 doctors took to the streets of Berlin to protest that medical care was “over-regulated” by the state. The association's president, Jörg-Dietrich Hoppe, pointed out that the reform plan was incapable of solving the financial problems in health care and was instead likely to result in more rationing. Hospitals would go bust because of their decreased budgets, he said.
The state health insurance companies, which number about 250, have organised a public relations campaign against the government's plan for a new fund that would collect all insurance premiums and then pass them on to the individual health insurance companies. The overall fund is criticised as an additional “bureaucratic monster.” Private health insurance companies also said that they are considering legal action against the plan to force large increases in their premiums.
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