Abstracts by key term: Competition
Hospitals in Germany are often accused of over-provision and inadequate care due to unnecessary services and redundant locations. Drivers of this assumption are issues such as outpatient care and centralization. However, under-provision, which can result not only from a lack of capacity but also from a lack of competition between locations, is rarely considered. Competition for the best outcomes, however, would be a strong driver of high-quality healthcare. Data from the Federal Hospital Atlas were used to examine competition for typical treatment needs, the possibility of escalating emergency levels, and regional alternatives for special needs. For this purpose, a radius of 20, 30, and 50 kilometers was created around each location. For almost 30% of all treatment needs, a location lacked a competitor. This revealed strong regional differences between densely populated regions such as Berlin, Hamburg, and North Rhine-Westphalia, with almost consistent competition, and eastern, remote states, with a predominance of locations without alternative providers. An escalation of the emergency level would have been possible for more than 90% (from 1 to 2 or 3) or almost 80% (from 2 to 3) of the locations, provided the treatment situation had required it. Co-provision by neighboring states was particularly relevant for emergencies in Rhineland-Palatinate and Schleswig-Holstein (with escalation from 2 to 3). Alternative locations for certified facilities were predominantly found. However, the proportion of locations without competition in oncology depended heavily on the entity, being low for breast and colorectal cancer and high for stomach and bladder cancer. Overall, the results show that in Germany, neither regional aspects nor treatment reasons are equivalent living conditions in healthcare, especially when considering competition for quality. The discussion on eliminating potential over-provision and misprovision of inpatient services must therefore urgently be supplemented by the aspect of building additional capacity to compensate for undersupply.
04.08.2025
Ensuring the supply of medicines through pharmaceutical wholesalers
Legal security mandate in the light of current competition policy developments
04.02.2023
The introduction of individual contracts in the area of pharmaceuticals enabled the statutory health insurance companies to carry out further structural development, so that the significant savings potential, particularly in the generics market, could be leveraged. Since 2003, health insurance companies have had the option of concluding discount agreements with drug manufacturers. With the legal changes to the GKV-WSG, these contracts have been able to take effect since 2007, since since then pharmacists have also been obliged to sell discounted products unless the prescribing doctor has ruled out substitution.
24.01.2013
Pay for Performance – An Option for Germany? Germany is considered a developing country when it comes to "pay for performance" (P4P). P4P has also established itself in Germany as a term for strategic compensation systems in which a portion of compensation is tied to measured performance levels. Two recently published reports (Veit et al. 2012 and Charlesworth et al. 2012) […]
25.09.2012
The German healthcare system is in a “financial crisis”. The expenditure on services is constantly increasing due to demographic change and the possibilities of medical progress. At the same time, the number of contributors is decreasing. Politicians have been trying to address the existing financing gap for years through “cost containment laws”. The introduction of competitive elements is a starting point for solving the existing problem.
23.09.2012
Since the legislator activated the option of drug discount contracts in the GKV Competition Strengthening Act (April 2007), corresponding discount contracts in the generic market segment have developed into a successful model. On the other hand, the objections repeatedly raised by interested parties, in particular pharmaceutical companies, with regard to patient compliance or alleged market share losses of pharmaceutical SMEs, stand up to neither public opinion nor empirical scrutiny. Discount agreements form an efficient and forward-looking competitive instrument between statutory health insurance companies and the pharmaceutical industry.