Health planning in Germany

Fundamental principles: decentralisation, subsidiarity, corporatism

Abstract

Health planning in Germany is largely determined by the corporatist and decentralised structure of the healthcare system. From the very beginning, the State has outsourced central decision-making and management functions to
public, non-profit bodies representing purchasers and providers, i. e. compulsory social health insurance schemes and hospitals, outpatient care physicians and medical colleges. These organisations operate according to fundamental
principles such as solidarity, parity, subsidiarity and self-government, that is they are autonomous and self-governed bodies with mandatory affiliation.
While the government defines the legal framework, the system of self-governance is responsible for the operational steering of the healthcare system and the implementation of regulations. Corporatist associations have the legal
mandate to actively participate in the planning and guidance of the system. The highest and most influential non-governmental body in the German health system is the Joint Federal Commission consisting of equal numbers of repre-
sentatives from social insurance funds and providers organisations. The commission stipulates common rules for all levels of medical care, quality assurance guidelines and procedural guidelines for planning; over all is responsible for
the benefits package of the social health insurance schemes. While corporatism ensures a high level of participation and legitimacy, it also hampers the implementation of evidence-based policy measures according to health priorities.