Abstract The basic goal of the German health care system is equal access to all medical services for all citizens. The federal government sets the legal framework for the system, but most health policy decisions are made through bargaining between large organizations within a legal framework. The federal government took little active role in health care until the early 1990s, when it became increasingly apparent that budgeting and other cost containment measures seemed to be insufficient to successfully reduce the growth of mandatory sickness funds expenditures. A 1993 law has attempted to address some of the most obvious deficiencies in the system, while encouraging a market-oriented approach to health care. Health care technology assessment has almost no role in the German health care system. Attempts by professionals and politicians to introduce technology assessment into the health care arena have been largely unsuccessful.