Summary: Compared with the United States, Germany has successfully controlled the growth rate of health care costs. Since 1980, it has kept its percentage of national wealth spent on health care between eight and nine percent of gross domestic product while covering a broad range of health care services for virtually the entire population. Despite these successes, the German government became concerned about growth in health care premium costs in the Statutory Health Insurance System, which covers the great majority of Germans. In 1992, Germany enacted health care reform legislation that imposed strict nonnegotiable budgets lasting up to three years on major sectors of the system, including hospitals, ambulatory care physicians, prescription drugs, and dentists. A series of structural reforms intended to control outlays over the longer term are expected to be worked out over the remainder of the decade. A July 1993 GAO report (GAO/HRD-93-103) discussed the nature and extent of these changes. This report covers the effects of the first year of strict budgets on cost and access to care and briefly discusses the status of the structural changes intended to allow the Statutory System to contain costs over the longer term.
