Web-economic-crisis-health-systems-and-health-web

Germany
Klaus-Dirk Henke and Wilm Quentin
Economic trends
• Real per capita GDP in Germany declined in 2009 but otherwise the
country has been largely unaffected by the crisis.
• Ten-year bond rates have dropped and are among the lowest in Europe.
• Unemployment has been decreasing since 2008, reaching 5.9% in 2011.
• Health as a share of government spending was in the top quintile of
European countries from 2008 to 2011. Nevertheless, per capita public
spending declined by 0.5% in 2011 (Germany: Fig. 1).
• Germany Fig 2 gives the trends in per capita spending on health.
Policy responses
Changes to public funding for the health system
• In 2009 the revenue of the Central Health Fund fell short of predicted
revenue by €2.5 billion.
• The Central Health Fund was able to accumulate reserves of €12.7 billion
between 2009 and 2012 (in addition to sickness fund reserves of
€14 billion in 2012) as a result of tax transfers and a very stable job
market.
• The federal government reduced the national SHI contribution rate from
15.5% to 14.9% of wages from mid-2009 to the end of 2010, with the
difference (0.6%) funded from the federal government budget (mainly
tax revenue); the SHI contribution rate was raised back to 15.5% at the
beginning of 2011.
• The federal government increased its tax subsidy to the Central
Health Fund to €7.2 billion to compensate for a reduction in the SHI
contribution rate (2009).
• The tax subsidy was increased in 2010 (to 15.7 billion), was maintained
in 2011 (to €15.1 billion) and lowered in 2012 (€14 billion) and 2013
(€11.5 billion).
• Sickness funds were allowed to charge flat-rate additional premiums (in
addition to income-related contributions) (2009).
• Some sickness funds introduced additional premiums but by the end of 2012
only one sickness fund still charged additional premiums.