No abstract

No abstract

While the total population in Germany is expected to diminish until 2050, the proportion of old and very old persons will rise considerably. The annual frequency of sicknesses, clinic days, and fatalities of old persons will likewise strongly increase. This raises difficult problems for the future design of the German public health care system. In any case, reforms will contain elements of rationing which will lead to a less expansion of the field of activity for geriatric physicians and surgeons than the purely demographic development would suggest. This dampening effect of rationing reforms on geriatric medical treatment and surgery, however, might possibly be least when done in an age-specific way and combined with long-term individual provisions through savings and health insurance.

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Moral hazard in an insurance system can be reduced by introducing copayments.Unfortunately, this may exert undesired distribution effects, which are generally regarded to be of specific relevance in the health sector. The article concentrates on an obligatory social health insurance system and tries to show that rightly adjusted and double-differentiated copayment rates can at least partially resolve the dilemma between allocation and distribution.The differentiation considered is with respect to income and to treatment sickness costs.The argument is presented by means of diagrammatic exposition.