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Der Homo oeconomicus im Gesundheitswesen

Publication Date
  • Political Science
  • Politikwissenschaft
  • Bundesrepublik Deutschland
  • Gesundheitswesen
  • Gesundheitsversorgung
  • Gesundheitspolitik
  • Gesundheitswirtschaft
  • Gesundheitsdienst
  • Homo Oeconomicus
  • Moral
  • öffentlicher Haushalt
  • Medizinische Versorgung
  • Sozialpolitik
  • Lohnkosten
  • Lohnnebenkosten
  • Krankenversicherung
  • Krankenkasse
  • Arbeitslosigkeit
  • Beschäftigung
  • Wirtschaftswachstum
  • Ökonomie
  • Wettbewerb
  • Marktwirtschaft
  • Gesundheitspolitik
  • Health Policy
  • Descriptive Study
  • Deskriptive Studie
  • Economics
  • Medicine
  • Political Science


"German textbooks on health economics are generally based on the concept of homo oeconomicus. If this basic paradigm of neoclassical economics is not simply understood as a truism (people make the best of any situation), then it finds itself on shaky empirical ground as has been shown by Mark Pauly in his discussion of 'moral hazard'. According to Pauly the public financing of health care services provides false incentives, because such financing leads to consumers accessing more services than they actually need. Pauly states that this systematic over-consumption of medical services can only be restricted through implementing co-payments or franchising arrangements. Pauly's position is, however, based on the incorrect assumption that medical treatment is a positive experience of which consumers cannot get enough. Co-payments only have a rational impact on medical service use if the patients have a real choice of products or services, for example, in the case of reference price system. If there is so little evidence for the rationality of co-payments, why has this tool been part of each cost containment measure over the last thirty years in Germany? German health care and welfare politics are dominated by a highly ideological debate on the cost of labour due to fringe benefits and the impact of high labour costs on the country's standing in the global job market. Health insurance contributions are seen as being a major part of the benefits package, thus contributing to the high cost of German labour, resulting in high unemployment rates. It follows that cuts in health care benefits are believed to give a new impetus for economic growth and the creation of new jobs. Although there is no real proof for this claim, it continues to dominate public opinion. Another paradigm of neoclassical economic theory concerns the central role of competition. Here there are two schools of thought, their protagonists being Walter Eucken and F.A. von Hayek. Eucken argues that the free market economy has a suicidal tendency toward the creation of monopolies and therefore pleads for controlled competition. Hayek, on the other hand, has a dogmatic free market stance, refusing all forms of political intervention. These fundamentally different views strongly influence the German debate on competition among statutory health insurance providers. It is clear that such a competitive system can only work properly if the risk burden born by the varying insurers is taken into account, those insurers having more high-risk members receiving a special compensation. If the insurers bearing a higher level of the overall burden receive no such compensation, then competition will take place at the expense of those insurance providers with a disproportionate number of members with chronic diseases and/or having a lower socio-economic status." (author's abstract)

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