Summary: Despite an enviable record in health care cost containment and universal coverage, the German government decided in 1993 to impose emergency budget caps and begin structural reforms of its health care system. Germany's universal coverage and well-organized administrative framework, which make it easier to monitor provider fees and monitor service utilization, bolster that country's ability to respond to changing health market conditions. But Germany still faces many cost pressures from an aging population, expanding demands for high-technology care, and consumer demands for high-quality care and choice. Germany's past experience and current reforms using global budgets, physician fee schedules, and constraints on resource growth could provide valuable insights for the United States as it grapples with health care reform. The German experience in refining, changing, and adapting some of the same tools being considered in U.S. reform proposals underscores the dynamic nature of the health care market. One of the most important lessons from Germany is that health care reform is a continuous process. As the United States moves toward comprehensive health care reform, the flexibility to respond to a constantly changing health market will be crucial.
