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Towards sustainable health care systems, Strategies in health insurance schemes in France, Germany, Japan and the Netherlands - a comparative study

Henke K-D, Schreyögg J
International Social Security Association. London: Transaction Publishers


Lupe [1]
Lupe [2]

In France, Germany, Japan and the Netherlands, health care expenditures grow while revenue remains at the same level or even shrinks, and medical progress, ageing and other factors are widening this gap over time. The pay-as-you-go approach is reaching limits, either with rising employer and employee contribution rates in the “Bismarck systems” or with higher taxes in the “Beveridge systems.” Neither of these systems is able to regulate itself quasi-automatically. Political interventions are needed with increasing frequency, and patchwork repair is evident everywhere. Major reforms are either too difficult or politically unmanageable in the highly sensitive and complex area of health care. This situation explains why in Europe and Japan, the public is calling for more substantial and longer lasting reforms. The solution to this situation is relatively easy. The nations facing financial gaps can:

- Cut back expenditures through budgets, exclusion of benefits and services or both.

- Increase revenue through higher contribution rates, a broader base for financing, higher co-payments and out-of-pocket-expenditures or some combination of these mechanisms.

- Institute major structural reforms to close the financial gap. These reforms can be accomplished through the ability-to-pay-principle or the benefit or insurance principle. All four nations examined in this report implement these theoretical approaches at one time or another, but there are differences in the way they do so. A comparison of their approaches might be beneficial to them as they face continuing challenges in closing the gap between health care expenditures and revenue.

Weiterführende Links

  • 2004.henke ISSA [3]
  • 2004.henke ISSA.Summary-e [4]
  • 2004.henke ISSA.Summary-x [5]
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