The future of the health care system in Germany

As a think tank and service provider for the government, the Innovation Centre in Lower Saxony, together with ScMI, created scenarios for the future of the “healthcare industry”. The future scenarios, which are demonstrated in a scenario study, should stimulate thought processes and discussions.

The rapid growth of medical knowledge and technological innovations for diagnostic, therapeutic and nursing procedures have led to an increasing differentiation of the modern health care systems. At the same time, cost pressure and quality expectations increase so that the coordinated corporation between the actors in the health care sector takes an increasingly prominent position. How dynamically the second growing health market is developing, is unclear. Furthermore, the demographic development which will lead to an increase in chronic diseases due to the rising number of senior citizens will require specific attention in the health care sector. These challenges have to meet the future structures in the health care system.

As a think tank and a service provider for the federal state government, the innovation center of Lower Saxony GmbH is responsible for thinking beyond today. Therefore, nine scenarios for the future of the health care sector were developed in a joint project with ScMI:

 

Supportive society controls competition (Scenario 1)
High-quality care through a competitive health care system with solidarity-based financing: In a prospering and individualized society health becomes one of the main future topics. The public authorities rely on an active health policy which involves all the decision-making levels of the countries from the federal government and the European Union. They establish a public financing on solidarity principles and create a framework for more competition. The health care system guarantees high-quality basic medical care and coverage, whereby the service provision takes place increasingly as part of diverse and integrated care models. At the same time, health has become a global growth market where companies position themselves successfully and where the German health care has become attractive for foreign patients.
Key player in the global growth market (Scenario 2)
High-quality care in a globalized health care industry: in a prospering society of responsibility, health has become one of the main topics as well as a global growth market. Many people are health-conscious and the politics create – especially at the federal and EU levels – a framework for a competitive health care system. Its financing is carried out primary through insured persons within the public health care as well as through increasing private provision. The diverse health care system, including Hartz IV approaches, guarantees a high-level basic medical care and coverage. German companies and service providers position themselves successfully on the global markets.
Lifestyle-sector is disconnecting itself (Scenario 3)
High-quality health care as a standard with health-related leisure industry as a separated growth market: In a booming and individualistic society of opportunities, health is “in a literal sense” guaranteed through high-level basic medical care and coverage and it is taken for granted. Most of the people pay more attention to superficial aspects and they consider “health” as a lifestyle. Thus, the leisure-oriented health industry is developing itself as an independent growth market besides the strongly privatized “first” health care in terms of financing and service provision, which is characterized by health insurances and pharmaceutical companies. Both sub segments are strongly globalized, whereby German companies position themselves successfully and service providers push the “lifestyle location Germany” forward.
Brussels relies on innovation and free market powers (Scenario 4)
Scenario 4 operates in an environment with high growth, strong competition, a reserved policy and with problems in basic insurance. The European health policy secures high-level care and competent handling with new diseases – at the expense of a “health divide”: in a strongly deregulated and progress-oriented society of opportunity, health has become an important issue and also a global growth market. In light of new and severe symptoms, the EU has become a central player in the health policy. Relying on technological innovations, for example in the biotechnology, and establishing a health care funded by the private sector and created by private service providers where a great majority have access to high level coverage. German companies and service providers position themselves successfully, whereby they are increasingly no longer recognized as national providers.
Self-do – price-conscious patient (Scenario 5)
Increasing responsibility within private health care and low-price segment: In a deregulated society people pursuit of safety, community – and thus also of health. Since the economic development is rather modest, fewer and fewer people can afford the full services of health care (or even merely healthy nutrition) which is bound to private financing. At the same time, they are very demanding and critical as consumers and patients, so that a strongly increasing market for low-price-health is developing where elements of the leisure-oriented health care industry are integrated.
Health as locational handicap (Scenario 6)
Escaping from privately funded, inferior, public health – Germany is being left behind in the growth cycle: In a society that is falling back into global competition, the people are yearning for safety, community and for wealth that is lost. In this situation health is not a central topic (any more). The state limits the public expenditures for health and shifts an increasing part of funding into private provisions. Since the attractiveness of the market for private investors is limited, the health care will still be supported by public providers who can only guarantee a reduced basic care as well as limited coverage.
Renaissance of public health (Scenario 7)
Freedom of players, driving employment – but decline in standards: an increasing number of people see the cause for the economic crisis and the declining wealth rooted in globalization and deregulation. Therefore, it came to a Renaissance of policy during which health care is seen as a public good and privatization is being halted and in some cases even reversed. In doing so, the federal government and the federal states are aiming that the health care industry acts as a motor for employment. During the definition of the national health care system, they rely on self-organization of the service providers in integrated care models, which consequently cements the traditional structures rather than sustainably improving the quality of care.
Rien ne va plus (Scenario 8)
Insured persons and taxpayers finance the rigid health care system with low-quality of care: In a stagnant economic environment, people seek for safety, cling to the present and refuse changes. In the health care sector the federal and state policy is not able to establish new structures in spite of strong regulation. Resulting fiscal gaps are plugged continually through additional contributions or state subsidies. Many service providers act in a competition-oriented environment and the quality of basic care and coverage decreases rapidly. Even politically desired prevention fails due to the conversion.
Yes, we can – but not everything (Scenario 9)
Scenario 9 describes a possible future in an environment of low growth, little competition, active regulation and basic insurance problems. National health policy ensures high quality basic medical care. However, lack of innovation drives patients abroad: In a society characterized by economic problems, many people strive for safety and rely even more heavily on the capability of politics. In particular the federal government considers the health policy as a main topic, whereby it relies less on new structures but rather on efficiently shaping the existent health care system. In particular, through information technology a high-level of coverage is being established. The Achilles’ heel of the development is the low level of innovation, leaving Germany lagging behind international standards in terms of new technologies and processes as well as in challenging additional services.

These external scenarios enable the innovation center of Lower Saxony to think through the framework conditions of the health care policy in Lower Saxony from an early stage.

Thinking through possibilities for action through strategy scenarios

In addition to this external perspective, the internal perspective was undertaken in a second sub-step. The aim was to describe possible futures. These so-called strategy scenarios contain three aspects: the health policy in Lower Saxony, the political environment of the health policy as well as the players of the health industry in Lower Saxony.

Seven strategy scenarios were developed in this follow-up process. The spectrum ranged from health policy, which is driven by constraints, to liberal and sustainable as well as research- and employment-oriented policy approaches. In order to classify those strategy scenarios the initial situation was classified and the currently followed strategy was established.