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Economization and Marketization in the German Healthcare System: How Do Users Respond?

GPS, Vol. 5 No. 1, (2009)

The focal figure of governance reforms within the German healthcare system is nowadays the ―expert patient‖. Both, state-driven agendas of user activation as well as market-based healthcare services emphasize self-responsibility, financial stakes and participation of healthcare users. Users act in different contexts as citizens, patients, consumers or commu-nity members. Depending on the situation, there is a demand for specific health knowledge and competences (―health literacy‖). In order to clarify which healthcare arrangement sup-ports a specific notion of the user, this article is based on a differentiation between econo-mization and marketization processes—both theoretically and empirically. Against this backdrop key questions read as follows: What does the challenge of more choice mean for patients as healthcare consumers? To what extent does the increasing significance help to co-produce and co-finance healthcare, influence patients‘ autonomy and agency? Which incentives do users face with regard to cost containment policies? It is argued, that it needs both, a general commitment by users as well as a healthcare system that strengthens users‘ agency and provides them equally with opportunities and advocacy.

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