Can they or won't they?

Abstract

Almost all experts agree that the German healthcare system has reached its limits and needs to be comprehensively overhauled. Although insured persons and taxpayers spend a great deal of money on healthcare, they do not always receive top-quality services in return. This is despite the fact that highly competent service providers are active in the healthcare system and efficient facilities and structures are available in many areas. On the other hand, there are brakes on performance that create dysfunctionalities in various areas, sometimes with serious consequences: insufficient ability to compromise between federal and state policy, dysfunctional sectoralisation, discrepancies between supply and demand, competition between quality and economy and, on top of all this, the inadequate participation of patients/insured persons - after all, they finance the healthcare system! This article goes beyond the description of the current situation and attempts to analyse why Germany has not succeeded in translating the very good substantive and structural conditions into a modern, efficient and adaptive healthcare system.