ABSTRACT
Like in many other developed nations, the traditional German health-care system has come under increasing pressure over the past few decades. After the Second World War, it was, in particular, a growing number of people with health-care cover and a rapid expansion of health services that raised initial concerns about its viability, but at that stage the country’s booming post-war economy was able to provide the necessary growth and employment to cope (Gerlinger 2010). However, faced with issues like a slowing economy, globalisation pressures, demographic change towards an increasingly ageing population and their growing expectation to age well, technological advancements and rising costs of medical services, it became an obvious necessity for political and administrative decision makers to adjust the system to better cope with these new developments (Felder 2010; Funk 2010; Gerlinger 2010; Golz 2010). The immense pressure on Germany’s health-care system is illustrated by the dramatic increase in public spending on health from approximately €159 billion (9.6 per cent of GDP) in 1992 to €278 billion (11.6 per cent of GDP) in 2009, which translates into an increase in total expenditure on health per capita from €1,970 to €3,400 (Statistisches Bundesamt 2011).
