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A Long Farewell to the Bismarck System: Incremental Change in the German Health Insurance System

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

Germany‚Äôs health insurance system represents the archetype of the healthcare arrangement generally known as the ―Bismarck model‖. Core elements of this model are the manage-ment of healthcare by self-governing corporatist bodies and the funding primarily by in-come-related contributions, not by taxes. The German health care system has been in a dynamic transformation process since the early 1990s. We currently have a situation where elements of different systems exist side by side. In this contribution we argue that this transformation has already robbed the core elements of the Bismarck system of a great deal of their importance, and that it must be expected that their significance will continue to decline as the reform process progresses.

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