Web-economic-crisis-health-systems-and-health-web
Web-economic-crisis-health-systems-and-health-web 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.
388 Economic crisis, health systems and health in Europe: country experience % Germany: Fig. 1 Economic and fiscal indicators 2000–2007 and 2008–2011 60 55 50 45 40 35 30 25 20 15 10 5 0 −5 −10 −15 −20 −25 −30 _ _ _ _ ● ● _ _ ● ● _ _ _ ● _ Real GDP per capita growth _ _ _ _ _ ● ● _ _ ● ● ● _ _ _ Deficit/surplus (% GDP) _ _ _ _ _ _ _ _ _ _ ● ● _ _ _ ● _ ● _ ● _ _ _ _ _ Government spending (% GDP) _ _ _ _ _ ● ● ● ● ● _ _ _ _ _ Government health spending (% total government spending) _ _ _ _ _ _ ● _ ● ● ● ● _ _ _ 10−year bond rates _ _ _ _ _ _ _ ● ● ● ● ● _ _ _ _ _ Unemployment rate Notes: Deficit/surplus: Eurostat; 10-year bond rates: European Central Bank; Other indicators: WHO Health for All. Year 2000−2007 2008 2009 2010 2011 Germany: Fig. 2 Trends in per capita spending on health, 2000–2011 3000 Public spending per capita OOP spending per capita Non−OOP private spending per capita Per capita spending $, PPP 2000 1000 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 15 Growth % 10 5 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 Public spending per capita growth OOP spending per capita growth Note: Spending calculated from WHO Health for All. Non−OOP private spending per capita growth
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- Page 382 and 383: Bulgaria Antoniya Dimova and Mina P
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388 Economic <strong>crisis</strong>, <strong>health</strong> <strong>systems</strong> <strong>and</strong> <strong>health</strong> in Europe: country experience<br />
%<br />
Germany: Fig. 1 Economic <strong>and</strong> fiscal indicators 2000–2007 <strong>and</strong> 2008–2011<br />
60<br />
55<br />
50<br />
45<br />
40<br />
35<br />
30<br />
25<br />
20<br />
15<br />
10<br />
5<br />
0<br />
−5<br />
−10<br />
−15<br />
−20<br />
−25<br />
−30<br />
_ _<br />
_ _<br />
● ●<br />
_ _<br />
●<br />
●<br />
_ _<br />
_<br />
●<br />
_<br />
Real GDP<br />
per capita growth<br />
_ _<br />
_ _ _<br />
● ●<br />
_ _<br />
●<br />
● ●<br />
_ _ _<br />
Deficit/surplus<br />
(% GDP)<br />
_ _ _ _ _ _ _ _<br />
_ _<br />
●<br />
●<br />
_ _<br />
_<br />
● _ ●<br />
_<br />
●<br />
_ _ _ _ _<br />
Government<br />
spending<br />
(% GDP)<br />
_ _ _ _ _<br />
● ● ● ● ●<br />
_ _ _ _ _<br />
Government<br />
<strong>health</strong> spending<br />
(% total government<br />
spending)<br />
_ _ _ _ _<br />
_ ● _ ●<br />
●<br />
●<br />
●<br />
_ _ _<br />
10−year<br />
bond rates<br />
_ _ _ _ _<br />
_ _<br />
●<br />
●<br />
●<br />
●<br />
●<br />
_ _ _ _ _<br />
Unemployment<br />
rate<br />
Notes: Deficit/surplus: Eurostat; 10-year bond rates: European Central Bank; Other indicators:<br />
WHO Health for All.<br />
Year<br />
2000−2007 2008 2009 2010 2011<br />
Germany: Fig. 2 Trends in per capita spending on <strong>health</strong>, 2000–2011<br />
3000<br />
Public spending per capita OOP spending per capita Non−OOP private spending per capita<br />
Per capita spending $, PPP<br />
2000<br />
1000<br />
0<br />
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011<br />
15<br />
Growth %<br />
10<br />
5<br />
0<br />
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011<br />
Public spending<br />
per capita growth<br />
OOP spending<br />
per capita growth<br />
Note: Spending calculated from WHO Health for All.<br />
Non−OOP private spending<br />
per capita growth
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