ABSTRACT
This chapter looks at overall themes in German politics in order to understand the parameters within which health policy reform efforts have been designed. Through the evolution of the German health care system one finds several themes that have developed that characterize the political side of the health care equation. The chapter examines the structure of the German health care system and focuses on the financing of the system and the delivery of services. Managed competition would allow sickness funds to increase their income through better management and lower expenses through increased competition. And managed competition appeared to be at the time the only politically appealing option by default. The explanation of the German flirt with managed competition may lie in the two characteristics, the power struggle between different key parties and the macroeconomic policy goals of the country.
