Chapter 9: Health Policy in Germany: Consumer Groups in a Corporatist Polity
Jens Geissler The making of German health policy is characterized by a corporatist ‘division of labour’ between, on the one hand, parliament, government and the Ministry of Health and, on the other, numerous self-governing bodies (especially insurance funds and doctors’ associations) to which considerable responsibilities have been delegated. In this arena there is no individual organization that can claim to speak for ‘the patient’. However there is a highly differentiated scene of patient organizations, with a large number of organizations targeting different groups, especially the chronically ill. These organizations have developed structures adjusted to the complexity of the German health care system with its large number of decision-making bodies. Patient organizations act as advocacy organizations when interacting with the political sphere. Umbrella organizations and senior citizens’ organizations are especially involved in debates about the general structure of the health care system and its funding arrangements. The patterns of interaction have long remained essentially unchanged. However patient organizations have recently been given a larger role in the self-governing bodies of the health insurance system. In particular, in 2004, health consumer groups were granted observer status on the Federal Joint Committee (Gemeinsamer Bundesausschuss) which makes final decisions about health insurance benefits. Since 2000 health insurance funds have been required to spend €0.56 per year per insuree to support patient organizations. After initial difficulties and a simplification of funding procedures, insurance funds are starting to reach this amount, which supports patient organizations’ self-help, information and lobbying activities. Organizations applying for funding have to...
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