Targets for health in Germany

Abstract

Background: Health care policy in Germany is dominated by economic (cost-containment), institutional and supply issues. Public health in general is low on the political agenda with much scope for improvement. Better health as an objective in itself has by and large been a neglected issue. Health targets are conceived of as the most promising instruments for bringing the health issues back in. This article focuses on i) the health target activities at the federal and Lander (states) level, ii) the focus of the programmes and iii) the political strategies required for successful implementation under the German institutional settings. Methods: A survey of health target programmes (analysis of policy documents) with a focus on contents (application of a modified health system model) and political strategies (application of a model for political coordinates) was used. Results: After a failed attempt to introduce health targets by the federal government in the 1980s, various states introduced or started planning health target programmes in the 1990s. These programmes vary widely in scope and focus. Meanwhile, the competent actors in the health policy arena have picked up the concept in order to make it fruitful for health care and bridge the gap between public health and health care. Moreover, health targets have reappeared on the federal political agenda. Conclusions: While the health target movement in Germany is gaining momentum the crucial issue of finding a political balance between the federal, Lander and local institutional levels remains unsolved. The future prospect of health targets in Germany will depend on solving this problem.