Health reform in Germany

from Wikipedia, the free encyclopedia

As health care reform in Germany measures are legislators on structuring the health care referred. The main goal of such reforms in recent times has been to curb the cost development in the statutory health insurance (for example by stabilizing the contribution rate and thus the non-wage costs by restricting services, increasing co-payments or by changing the remuneration of service providers ). In the past, however, such reforms often resulted in an expansion of benefits or the inclusion of larger sections of the population in social security . Most health reforms are intended to bring about a short-term change in the financing of medical services. In contrast, the promotion of preventive approaches to prevent disease-related costs has mostly played a lesser role in previous health reforms. The term health reform has only been used since the Health Reform Act came into force in 1989; before that, there had been talk of cost-containment laws and corresponding measures since 1977 .

history

Health reforms 1976–1983

This article or section consists mainly of lists, which should be replaced by running text . Please help Wikipedia improve this. More about is here to find.

  • 1983 Household Accompanying Act (now 2 DM (1 Euro) per drug, the day in hospital cost 5 DM (2.50 Euro) per day - a maximum of 70 DM (36 Euro); in the health insurance of the pensioners now the pensions, pension payments and besides earned income from self-employment subject to contributions, payment of the contributions for pensions / pension payments on an equal footing with recipient and paying agent)
  • 1982 Supplementary Act to Reduce Costs (now 1.50 DM (75 cents) per drug, for glasses and remedies such as massages and baths 4 DM (2 euros) per prescription. For glasses, around 4 DM (2 euros) were also due)
  • 1977 Cost Reduction Act (including drug maximum amounts and service restrictions, minor drugs are no longer paid, co-payments per drug, bandage and remedy are introduced. In the past, the insured had a fee of at most 2.50 DM (1.25 euros) per prescription now 1 DM (50 cents) per drug. The upper limit of the personal contribution for dentures of 500 DM (256 euros) was canceled.) The concerted action in the health service was set up, where the participants in the health service should agree on measures to reduce costs.
  • 1976 Reduction of the contribution of the pension funds to the health insurance of pensioners from 17 to 11%. A pension increase would not have been possible in the 1976 Bundestag election year without this measure. The then responsible Federal Minister Herbert Ehrenberg (SPD) was therefore accused by the opposition of lying about pensions.

The 1989 health reform

With the health reform law "GRG" under Norbert Blüm (CDU), the statutory health insurance was taken over from the 2nd book of the Reich Insurance Code ( RVO) from January 1, 1989 into the fifth book of the Social Code (SGB V) and the law on the health insurance of farmers until Replaced to a few regulations by the Second Law on Health Insurance for Farmers (KVLG 1989 - BGBl. I p. 2477 ).

Other changes included the introduction of a “negative list” for drugs judged to be uneconomical by the Federal Ministry, the introduction of fixed prices for drugs (if the price is higher, the patient has to pay the difference) and a higher prescription fee for drugs. In the case of non-price-linked preparations, the surcharge was now 3.00 DM instead of 2.00 DM. The clinic surcharge was doubled. A significant deductible (between 40 and 50% of the cost) for dentures was introduced.

Even workers were now exempt from insurance if they exceeded the annual wage limit , which replaced the previous annual wage limit; previously this only applied to employees. The differentiation between workers and employees was abolished. The possibility of voluntary continued insurance was largely restricted. A so-called solidarity model was provided for workers and employees, according to which both groups of workers did not have the right to join a substitute fund if their remuneration did not exceed DM 3,600 (EUR 1,841) and were not insured with a primary fund for at least 5 years. In the service area, extended early diagnosis examinations and services of a home care assistant in the case of need for care have been included. The costs for dentures were only covered by the health insurance up to 50% and those of an orthodontic treatment in the form of a reimbursement of costs up to a maximum of 75% and that only if the treatment was successfully completed. The death benefit of health insurance was cut.

Health reforms 1993–2002

This article or section consists mainly of lists, which should be replaced by running text . Please help Wikipedia improve this. More about is here to find.

The dates of the individual changes are listed:

  • 2002 Contribution Rate Protection Act "BSSichG" under Ulla Schmidt (SPD) (including reduction in death benefit , further tightening of budgets for doctors' fees and hospitals)
  • 2002 Law to limit drug expenditure by statutory health insurance (drug expenditure limitation law - AABG)
  • 2001 Law to replace the drug and medicinal product budget (Drug Budget Replacement Act - ABAG)
  • 2000 GKV health reform (including tightening of the budget for doctors' fees, medicines and hospitals. Recourse if the budget is exceeded)
  • 1999 Statutory Health Insurance Solidarity Strengthening Act (SPD-Greens) (including reintroduction of the budgets for doctors' fees, hospitals, medicine and medicine budgets. Those born after 1978 were also entitled to dental prostheses again. The co-payments for medicines and medicines were reduced.)
  • 1997 GKV reorganization laws under Horst Seehofer (CSU) (including further increased co-payments for drugs and remedies between 4.50 and 6.50 euros. A hospital day cost 7 euros - "hospital emergency victims", rehabilitation up to 12.50 euros. In addition, with a few exceptions, the health insurance subsidy for dentures was canceled for all those born in 1979 or later.
  • 1996 Contribution Relief Act (including cancellation of the subsidy for dentures for insured persons who were born after December 31, 1978 (valid until 1998), no more reimbursement for glasses frames, increased co-payments for pharmaceuticals, reductions in benefits and co-payment increases for health cures, reduction in sick pay)
  • 1993 Health Structure Act , also known as the “ Lahnstein Compromise” between Horst Seehofer (CSU) and Rudolf Dreßler (SPD) (including free choice of health insurance from 1997 for all insured, introduction of budgeting , increased co-payments for medication, co-payments for dentures and remedies as well for hospital treatment increased. The amounts for medication have been graded according to package size)

The 2004 health reform

In the course of implementing Agenda 2010 , the government and the opposition (SPD / Die Grünen and CDU / CSU, FDP) agreed in the summer of 2003 on the “Law to Modernize Statutory Health Insurance” ( GKV Modernization Act for short , GMG).

A noticeable change that came into effect with the law to modernize statutory health insurance under Ulla Schmidt (SPD) from January 1, 2004, is, in addition to the abolition of the maternity and death benefits, the introduction of a patient contribution: 10 euros practice fee per quarter, 10% co-payment for medicines and aids - a minimum of five and a maximum of ten euros, 10 euros per hospital day limited to 28 days. Non-prescription drugs, travel expenses (to outpatient treatment) and glasses must be completely worn by the patient, and childbirth and death benefits are canceled. Since then, the upper limit for co-payments has been 2% (for the chronically ill 1%) of gross annual income. The aim of the reform was to reduce the average contribution of statutory health insurance to around 13% of income over the next few years (on July 1, 2003 it was 14.4%).

A regulation was initially planned for dentures , according to which, from January 1, 2005, an additional income-independent contribution should be levied from the insured alone. From 2006 onwards, sick pay should also be financed without employers' participation. On October 1, 2004, the Bundestag decided with the votes of the red-green coalition that the statutory health insurance contribution would initially be reduced by 0.45% for employers and employees from July 2005, but at the same time for employees a special contribution of 0.9 % have to pay. The parity of the contribution payment was thus canceled.

The aim of the reform was to reduce the average contribution of statutory health insurance to around 13% of income over the next few years (on July 1, 2003 it was 14.4%) in order to reduce non-wage costs. In addition to the elements aimed at relieving the financial burden on employers, approaches to structural changes can be identified. Both the duality principle (distribution of social contributions between employees and employers) and the solidarity principle (economically stronger and healthy people pay more than economically weaker and sick people) are weakened.

The 2007 health reform

Coalition agreement

In the coalition agreement between the CDU, CSU and SPD of November 11, 2005, the coalition parties agreed on a reform of health insurance, which should take into account the rising costs of health care due to medical progress and demographic change. It was a matter of formulating a compromise between the models of the health premiums of the Union parties formulated in the election campaign for the 2005 federal elections and that of the SPD's solidarity citizens insurance.

According to this, "a comprehensive future concept will be developed for the area of ​​statutory health insurance in 2006, which is also designed to keep the contributions to statutory health insurance at least stable and to reduce them as much as possible." In detail, the parties agreed that the health system in relation to the cooperation between private health insurances and public health insurances should get a more competitive orientation. The so-called health summit on March 29, 2006, attended by top politicians from the coalition parties, including Angela Merkel , Edmund Stoiber , Volker Kauder , Peter Ramsauer , Franz Müntefering , Peter Struck and Hubertus Heil , was postponed without any concrete results. Finding a compromise was seen by the SPD and CDU in the run-up to the negotiations as essential for the continued existence of the coalition. Federal Minister of Health Ulla Schmidt was not present at the talks, the then SPD party chairman Matthias Platzeck was absent due to a sudden hearing loss.

Cornerstones of the health reform

On July 3, 2006, the party leaders of the CDU, CSU and SPD agreed on the cornerstones of the health reform .

The federal government's plans for the 2007 health reform can be summarized as follows:

  • The health insurance funds are increasing their wage-related contribution rates in 2007 by approx. 0.5 percentage points , which is expected to generate additional income of approx. 5 billion euros. The employee and employer each pay half of the increase. The contribution rate thus reaches 14.7% of the gross wage on average for the health insurance companies . Of this, 6.9 percentage points are paid by the employer; the employee contribution continues to include the special contribution of 0.9% introduced in 2005 and will therefore amount to 7.8 percentage points on average. (At that time the legislature wanted to relieve employers of ancillary wage costs with this special contribution and thus promised an incentive to create jobs.) The original statement that the special contribution should cover the personal life risk of each individual for dentures and sickness benefits was quickly dropped. With this argument, all pensioners who are no longer entitled to sick pay would have to be exempted from at least a portion of the special contribution.
  • The tax-financed health insurance subsidy, which will be reduced in 2007 by 2.7 billion euros to 1.5 billion euros and which, according to the coalition agreement, should cease to apply from 2008, will now be retained. 1.5 billion euros are earmarked for 2008 and 3 billion euros for 2009. In the long term, the tax subsidy should continue to rise. It is intended to finance the contribution-free co-insurance of children in statutory health insurance in the future.
  • The wage-related contributions of employers and employees and the subsidy from tax revenues are to be distributed among the health insurers via a health fund. In addition, there is a supplementary insurance contribution that the insurance companies can collect directly from their respective insured persons. They are free to raise this additional contribution as a percentage of their income or as a flat rate per capita. The additional contribution is limited to a maximum of 1% of the income. Funds that spend less than they receive from the health fund can instead reimburse their members for contributions.
  • The current limit on doctors' remuneration to a fixed overall budget will be lifted. Instead, the remuneration will be converted to flat rates per service, per disease treated or per patient, which are set in a nationwide euro fee schedule. The focus should be on remuneration for complex services that belong together. If certain service quantities are exceeded, a doctor will only be allowed to charge gradually lower (graduated) prices.
  • The pharmacies have to pay a higher discount (2.30 euros) than before (2.00 euros) per prescription drug to the statutory health insurance companies. This corresponds to annual savings of around 180 million euros.
  • In private health insurance (PKV), insured persons should be able to take the old-age provisions that were formed for them with the previous insurance to the new insurance up to the amount that they would have accumulated if they had been insured in the basic tariff in the future would be. So far, the insured have lost this capital stock built up from their contributions in the private health insurance when they switch to another insurance.
  • Principle: "Outpatient instead of inpatient"
  • Compulsory insurance for all German citizens is agreed. According to this, in addition to statutory health insurances, private health insurances must also offer a uniform basic tariff with a minimum of services. The rejection of an application for inclusion in the basic tariff cannot be made as a result of a health risk assessment.

The tax financing of the fund is criticized because the costs in the health care system are becoming less transparent and, above all, because the lobby of the higher-income groups is resisting the expansion of solidarity to their full income for health insurance purposes. It may be illegal for privately insured persons to have to pay the contributions in full for themselves and for each of their own children as before, but also to pay taxes into other insurance policies that do not provide benefits. It is also criticized that the fund itself generates new costs for its administration. See also health fund .

Agreement in the coalition committee on October 5, 2006

After months of discussions in the expert groups and in the coalition committee, the grand coalition agreed on the following modifications to the key points:

The new health fund will not be introduced until 2009.

If the income from the health insurance from the health fund is insufficient, the health insurance companies have the option of charging an additional contribution . An excessive demand clause should apply, according to which the additional contribution should not exceed one percent of the household income. However, the compromise also provides that additional contributions of up to eight euros per month can also be levied 'without' an income test. Many media representatives see the postponement to 2009 - very close to the next federal election - as an indication that the idea of ​​a health fund has little chance of survival.

The coalition committee agreed on further points:

  • All citizens who currently do not have insurance coverage must be able to return to health insurance.
  • Instead of seven central associations of the statutory health insurance , there will only be one in the future.
  • The statutory insurance companies have more freedom in drafting contracts with service providers.
  • Expenses for hospital care are to be further limited. Some prime ministers have formulated clear reservations about this.

Adoption of the 2007 health reform

On February 2, 2007, the health reform ( GKV Competition Strengthening Act ) was passed in Berlin in the German Bundestag. With 378 votes in favor, the Bundestag approved the controversial health reform. The opposition voted unanimously against it, including 23 MPs from the CDU / CSU and 20 MPs from the SPD parliamentary group. On February 16, the Federal Council gave its approval. On March 26th, the law was signed by Federal President Horst Köhler. The new health insurance essentially came into force on April 1, 2007.

Contents of the 2007 health reform

This article or section consists mainly of lists, which should be replaced by running text . Please help Wikipedia improve this. More about is here to find.

  • The first-time obligation of citizens to take out health insurance, provided there is no other coverage in the event of illness. (from January 1, 2009 or April 1, 2007)
  • a reform of the supply structure and the cash organization
  • a reform of private health insurance
    • From January 1, 2009, those insured in private health insurance can take their aging provisions with them to the extent that they would have accumulated if they had been insured in the basic tariff if they switched to private health insurance.
  • a reform of the funding regime
    • with the introduction of the health fund, a uniform contribution rate from January 1, 2009 in the statutory health insurance (initially 15.5%, during the economic crisis in 2009 14.9% and from 2011 again 15.5%), with well-performing health insurances making premium repayments and poorly performing additional contributions can raise. Criticism of the presentation of the BMG: If the risk structure compensation between the insurance companies with predominantly poor, sick and old and those with predominantly wealthier, younger and healthier patients turns out to be insufficient, the additional contribution has little to do with whether the insurance company is doing well , but solely what insurance structure it has. In a context that should not be underestimated, there is the newly created insolvency option for statutory health insurance companies.

The 2011 health reform

Health insurance contributions and additional contributions

As part of the health reform passed in November 2010, the general (reduced) health insurance contribution for statutory health insurance was increased from 14.9% (14.3%) to its previous level of 15.5% (14.9%) on January 1, 2011 . Previously, due to the financial crisis in 2007 as part of the economic stimulus package II , it had been reduced by 0.6%, financed with tax subsidies from the federal budget . The employers' share of the contribution rate of 15.5% was 7.3% and was frozen at this level.

Future cost increases should be compensated by the insured person through additional contributions for each individual health insurance fund . The then Health Minister Philipp Rösler justified this with the fact that rising health costs in the future should no longer automatically lead to an increase in ancillary wage costs . With the health reform, the limit on additional contributions was lifted. So that low-wage earners are not overwhelmed, social compensation has been introduced if the additional contribution exceeds 2% of gross income. Unemployment benefit II recipients, recipients of social assistance, military and community service, students, trainees, mini-jobbers and disabled people were excluded from the additional contribution. In the event of the introduction or increase of additional contributions, the insured received a special right of termination .

Law on the reorganization of the pharmaceutical market (AMNOG)

With the reform, the law for the reorganization of the pharmaceutical market (AMNOG) was passed. The reform made funds available to reduce drug prices. Among other things, Rösler was the first Federal Health Minister to enforce the drug benefit assessment ordinance (also known as “early benefit assessment”) against pharmaceutical companies in Germany. The pharmaceutical companies can no longer set the prices of new drugs freely and have to prove the additional benefits for new drugs. You are obliged to agree the price of the drug with the statutory health insurance within one year . If no agreement can be reached, a central arbitration board decides on the drug price. In this process, the Institute for Quality and Efficiency in Health Care (IQWiG) and the Federal Joint Committee (G-BA) can be commissioned as independent bodies to assess the additional benefit of drugs. Another important point is that the responsibility for inexpensive drugs has been transferred more and more from the doctors to the health insurance companies. The health insurance companies have z. B. with the drug discount agreements more means for price regulation. The bonus-malus regulation is thus lifted and the doctors are relieved. The regulation on prescribing special drugs (second opinion) has also been abolished.

With the AMNOG, it was also passed that antitrust law applies to voluntarily concluded contracts by health insurers and service providers. Exceptions to this are collective bargaining agreements and contracts that the health insurances or their associations are obliged to conclude, such as the contractual obligations for the supply of therapeutic products and aids . This change should prevent the restriction of competition by the health insurance companies. These came together in associations and were therefore in a very strong negotiating position. The health insurance companies criticized this change in the law, arguing that ultimately the insured benefited from the discount agreements. The Cartel Office calmed down and made it clear that the AMNOG would allow the practiced system of discount contracts as long as the health insurance companies did not exaggerate.

Private health insurance

With the 2011 health reform, the drug discounts were also extended to private health insurance. In addition, the three-year period introduced in 2007 has been abolished. Insured persons no longer have to be above the compulsory insurance limit for three consecutive years , but can switch to private health insurance if the limit is exceeded once.

GP contracts

In the health care reform in 2011, it has been written that fee increases for primary care physicians are not allowed to continue rising faster than the other doctors. The remuneration must also be more based on the general fee level for medical care. The GP contracts already concluded remain unaffected. Rösler explained this by saying that the population would not accept it if not all groups contributed to the consolidation of the health budget. The fees of family doctors had risen sharply in previous years and in 2009 even overtook the fees of specialists . Nevertheless, in the run-up to the reform, general practitioner associations expressed their displeasure with the planned changes. GPs threatened Rösler open with the return of approval from health insurance if it is not to despair of his plans and went on strike. However, the Federal Ministry of Health did not respond to their request and the family doctors finally gave up their protest after the Bavarian Family Doctors Association had not found a 60% majority among its members for a collective exit from the health insurance system.

Further regulations

  • The fee increases for contract doctors were limited for the years 2011 to 2012.
  • The administrative costs of the health insurance funds were frozen at the 2009 level for 2011 and 2012.
  • The already agreed expenses for the additional services provided by the hospitals will be reduced by 30% for 2011.
  • As of January 1, 2012, the premium for pharmaceutical wholesalers will drop to 70 cents per pack plus 3.15% of the manufacturer's selling price. Instead, in 2011 he has to pay 0.85% of the manufacturer's sales price as “his savings contribution”.

Criticism of the 2011 health reform

The health reform measures met with widespread opposition from unions, employers and social associations as well as from the opposition. The DGB spoke of a "challenge to the citizens". It has often been criticized that the increase in health insurance contributions for those with compulsory insurance contradicts the coalition agreement between the FDP and the Union. SPD parliamentary group leader Frank-Walter Steinmeier accused Rösler of failure and commented: "The government is starting the summer break with a grandiose breach of word." Criticism was also expressed in the ranks of the governing parties , for example by Prime Minister Stefan Mappus (CDU), Stanislaw Tillich (CDU) and Horst Seehofer (CSU).

The 2015 health reform

Under Federal Health Minister Hermann Gröhe (CDU), it was decided to introduce the additional contribution for each individual health insurance fund with effect from January 1, 2015 in July 2014. As a result, the health insurance contribution fell to the base contribution of 14.6%. Employers and employees share this 50% each. In addition, the statutory health insurance companies can charge an additional fee. In contrast to the additional contribution introduced in 2007, this is not calculated as a flat rate but as a percentage based on income. In 2015 it was between 0.0% and 1.3%, depending on the health insurance company. The additional contribution is to be paid by the employee alone.

Word of the year

In 1988 the Society for German Language chose the word “Health Reform” as word of the year , in 1996 it was one of the candidates for the bad word of the year.

See also

literature

  • Jan Böcken, Martin Butzlaff, Andreas Esche (eds.): Reforms in the health system. Results of the international research Carl Bertelsmann Prize 2000 , Verlag Bertelsmann Stiftung Gütersloh, 3rd, revised edition 2003, ISBN 3-89204-515-1 , download at bertelsmann-stiftung.de (PDF; 910 kB)
  • Alfred Boss: On the planned reform of the health system in September 2006 (PDF file; 37 kB)
  • Friedrich Breyer et al. a .: Health policy in the compromise trap: No problem solved, but new ones created (PDF file), in: Wirtschaftsdienst No. 8/2006, p. 515 f .; ISSN  0043-6275
  • Alexander Dietz: Just health reform? Allocation of resources in medicine from an ethical perspective. Campus-Verlag Frankfurt am Main 2011, ISBN 978-3-593-39511-1
  • Renate Hartwig: The sold patient: How doctors and patients are cheated by health policy Pattloch, Munich 2008. ISBN 978-3-629-02204-2
  • Andreas Hoffmann: Laborious compromise that creates problems . In: Süddeutsche Zeitung of July 5, 2006
  • Ingmar Kumpmann: Health reform: Increase in income instead of structural reform in: Institute for Economic Research Halle (Ed.), Wirtschaft im Wandel 8/2006, 23 August 2006 (PDF file; 658 kB)
  • Elisabeth Niejahr: First aid from The Hague . Health: In Holland there is a mixture of flat rate per capita and citizen insurance. In: Die Zeit No. 14/2006 of March 30, 2006, p. 27.
  • Ulrich Orlowski, Jürgen Wasem: Health Reform 2007 (GKV-WSG): Changes and effects at a glance. Health law in practice, CF Müller / Hüthig Jehle Rehm 2007. ISBN 978-3-8114-3236-9
  • Marco Penske: The health fund does not solve any of the financing problems of the statutory health insurance (PDF file), in: Wirtschaftsdienst No. 8/2006, pp. 510–516; ISSN  0043-6275
  • Christian Warns: Rules of the game of a solidarity health insurance competition - competition, solidarity and sustainability after the 2007 health reform , Herbert Utz Verlag, Munich 2009. ISBN 978-3-8316-0864-5
  • Jürgen Wasem: The history of the health reform law (GRG). In: B. v. Maydell (Hrsg.): Problems of social policy legislation - The example of the health reform law . St. Augustine, 1991
  • Jürgen Wasem, Stefan Greß: Health care and security in case of illness. In: Manfred G. Schmidt (Ed.): Federal Republic 1982–1989. Financial consolidation and institutional reform. Volume 7.1. of the series History of Social Policy in Germany since 1945. Nomos, Baden-Baden 2005
  • Jürgen Wasem, Stefan Greß, Franz Hessel, Aurelio Vincenti, Gerhard Igl: Health care and security in the event of illness and care. In: Gerhard A. Ritter (Ed.): Federal Republic of Germany 1989–1994. Social policy under the sign of unification. Volume 11 of the series History of Social Policy in Germany since 1945. Nomos, Baden-Baden 2007
  • Silke Weselski: Models for the reform of the statutory health insurance . VSSR 1/2006
  • Marion Wille, Erich Koch: The health reform 2007 . Munich 2007. ISBN 978-3-406-55715-6

Web links

Wiktionary: Health reform  - explanations of meanings, word origins, synonyms, translations

Sources and individual references

(2007 health reform)

  1. ^ Health reform . In: Duden Economy from A to Z: Basic knowledge for school and study, work and everyday life. 5th edition Mannheim: Bibliographisches Institut 2013. Licensed edition Bonn: Federal Agency for Civic Education 2013. Accessed on April 23, 2014.
  2. ^ Law on structural reform in the health system (Health Reform Act - GRG) of December 20, 1988 ( Federal Law Gazette I p. 2477 ).
  3. ^ Entry health reform . In: Brockhaus. Encyclopedia in 30 volumes. 21st edition. Updated with articles from the Brockhaus editorial team. Retrieved from Munzinger Online on April 26, 2014.
  4. ↑ Wasem J: Introduction to the law to dampen the development of expenditure and to improve the structure of statutory health insurance (Health Insurance Cost Reduction Act - KVKG). In: Collection “Das deutsche Bundesrecht” (610th delivery) , Baden-Baden, 1989, structure number VE-14, pp. 3–13.
  5. ↑ Bundesarbeitsblatt, special issue “Structural Reform in the Health Care System”, March 1989
  6. ↑ Together for Germany. With courage and humanity. Coalition agreement of the CDU, CSU and SPD for the 16th legislative period from 11.11.2005 (PDF)
  7. ↑ Key points paper of the grand coalition on health reform of July 4, 2006 (PDF) Text with commentary by Thomas Ratajczak
  8. ^ Alfred Boss: On the planned reform of the health system ( Memento from February 2, 2016 in the Internet Archive ) (PDF) Institute for World Economy IfW, 2006
  9. ↑ Individual voting behavior of the 614 members of the Bundestag on health reform on February 2, 2007 on parliamentwatch.de
  10. ↑ Outlook: This is coming 2011 fr.de, December 31, 2010.
  11. ↑ Numerous changes at the beginning of the year Krankenkassen.de/dpa, January 2, 2011.
  12. ↑ Health insurance contribution 2011 Sozialversicherung-kompetent.de
  13. ↑ Bundestag resolves health reform ( memento of December 23, 2010 in the Internet Archive ), aerzteblatt.de , May 23, 2010.
  14. ↑ Hartz IV: Additional article 2011 deleted heilpraxisnet.de, November 2, 2010.
  15. ↑ Additional contribution: Not everyone has to pay bundesregierung.de, January 17, 2011.
  16. ↑ AMNOG and statutory ordinance: G-BA draws a positive balance overall despite reservations , g-ba.de , May 19, 2011.
  17. ↑ New drug market law strengthens the role of the Institute for Quality and Efficiency in Health Care . Federal Ministry of Health, press release, November 5, 2010. Retrieved May 19, 2011.
  18. ↑ Decision recommendation and report of the Committee on Health (14th Committee) (PDF; 6.9 MB). In: ebm-netzwerk.de , May 20, 2011.
  19. ↑ Antitrust law: Rösler wants more competition in discount agreements , Krankenkassen-direkt.de , May 20, 2011.
  20. ↑ Markus Grill: Invitation to Manipulation . In: Der Spiegel . No. 38 , 2010, p. 102-111 ( online - 20 September 2010 ).
  21. ^ Cartel office reassures health insurance companies apotheke-adhoc.de, September 29, 2010.
  22. ↑ healthcare reform private health insurance , cecu.de , May 24 2011th
  23. ↑ Important changes in the law of statutory health insurance from 2011 janvonbroeckel.de, May 20, 2011.
  24. ↑ Rösler rejects higher remuneration for general practitioners ( memento from July 19, 2010 in the Internet Archive ) aerzteblatt.de, July 14, 2010.
  25. ^ Strike despite increased fees fr-online.de, May 20, 2011.
  26. ↑ Family doctors depend on specialists for income t-online.de, May 20, 2011.
  27. ↑ Bavaria's family doctors: Exit failed blog.consilia-sozial.de, May 20, 2011 (archived website).
  28. ^ The Federal Government's drug savings package , 3sat.de , May 25, 2011.
  29. ^ The Health Reform 2010 State Center for Political Education Baden-Württemberg
  30. ^ Health insurance reform 2015 , last accessed on November 2, 2015.
  31. ↑ Law on the further development of the financial structure and quality in statutory health insurance , last accessed on November 2, 2015.