Access and choice - competition under the roof of solidarity in German health care: an analysis of health policy reforms since 2004

This paper analyses the influence of recent German health care reforms, the Statutory Health Insurance Modernization Act 2004 and the Statutory Health Insurance Competition Strengthening Act 2007, on different dimensions of access and choice. More specifically, we look at and discuss the effects of these policies on the availability, reachability and affordability of health care as well as on their impact on consumers' choice of insurers and providers. Generally, patients in Germany enjoy a high degree of free access and a lot of freedom to choose, partly leading to over- and misuse of health services. Concerning choice of insurers, one result of our analysis is that in the statutory health insurance system, the introduction of a greater variety of benefit packages will develop into an additional parameter of choice. In contrast to that, insurees more and more accept certain restrictions of choice and direct access to providers by enrolling into new forms of care (such as gatekeeping-, disease management- and integrated care programmes). However, they might benefit from better quality of care and more options for products and services that best fit their needs.