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The European Journal of Public Health 2001 11(2):174-177; doi:10.1093/eurpub/11.2.174
© 2001 by European Journal of Public Health
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RISK ADJUSTMENT IN SOCIAL INSURANCE SYSTEMS

Risk structure compensation in Germanys statutory health insurance

REINHARD BUSSE*

*Correspondence: Teinhard Busse, European Observatory on Health Care Systems, Madrid Hub, c/o Escuela Naclonal de Sanidad, Sinesio Delgado 8, 28029 Madrid, Spain, tel +34 91 387 7753, fax +34 91 387 7869, rbusse{at}iscui.es

In 1996 insurees in Germany’s statutory health insurance system were given a right to choose their sickness fund. To ensure that all funds had an equal starting position, a risk structure compensation scheme based on income and average expenditure by age and sex was introduced. From an analysis of expenditure and transfers, data on sickness fund membership and a published survey, the following effects can be identified: sickness funds merged, with a reduction in number from 1,221 to 420 between 1993 and 2000; the risk compensation scheme narrowed differences in contribution rates; insurees left the more expensive funds for cheaper ones; and increasing transfer sums indicate further risk segregation. Thus, the compensation mechanism will have to be retained permanently, although modifications are likely.

Keywords: Germany, financing, organized, insurance, health, insurance pools


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[Abstract] [PDF]


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