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Zeitschrift für Wirtschaftspolitik

Ed. by Donges, Juergen B. / Krause, Michael / Roth, Steffen J. / Watrin, Christian

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Volume 67, Issue 1


Was spricht gegen Zwei-Klassen-Medizin?

Friedrich Breyer
  • Corresponding author
  • Universität Konstanz, FB Wirtschaftswissenschaften, Postfach 135, 78457 Konstanz Germany, Tel.: (07531) 88–2568
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Published Online: 2018-05-01 | DOI: https://doi.org/10.1515/zfwp-2018-0005


In Germany, there is a lively debate on a so-called „two-class-medicine“, meaning that privately insured persons get better medical treatment than sickness fund members. As an economist, the author is not in a position to judge whether this is true. However, the co-existence of social and private health insurance (GKV and PKV) constitutes a „two-class-health insurance“, which leads to severe inequities in the distribution of the financial burden of illness. In this article it is shown that there are legal ways to address and eliminate these inequities without abolishing the private health insurance system altogether. The instruments are the inclusion of private health insurance in the risk adjustment scheme of the sickness funds and the transformation of the GKV contributions into flat per-person amounts, independent of earnings, accompanied by a tax-financed compensation for families with below-average income, as in Switzerland and the Netherlands. Interestingly, this second reform proposal has been vigorously opposed by all leftist parties ever since, who fight for the chimaera of a „people's insurance“, which sounds good but cannot be implemented in a legal way and, moreover, would not even eliminate „two-class-medicine“.


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About the article

Published Online: 2018-05-01

Citation Information: Zeitschrift für Wirtschaftspolitik, Volume 67, Issue 1, Pages 30–41, ISSN (Online) 2366-0317, ISSN (Print) 0721-3808, DOI: https://doi.org/10.1515/zfwp-2018-0005.

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