The 1992 health reform victory over pressure group politics

Abstract

The 1988 health reform was substantially undermined by the influence of powerful pressure groups representing the interests of the medical profession and the pharmaceutical industry and resistance from the German federal states. Consequently, it failed to achieve its aim of ‘cutting costs’. The theory supporting ‘resistance to reform within the health care system’ was widely accepted in the literature on the subject. The 1992 reform appeared to contradict this theory, as the political leadership succeeded in overcoming both party policy and intergovernmental differences, as well as making considerable cost savings and structural changes in spite of resistance from the opposition ‘lobby’. Three factors were responsible for this. They were under enormous pressure to act due to the financial crisis and the interdependent costs within the welfare state, the changing motives within the health care system, and a new political strategy which responded to this. In the long term, prospects are for a trend towards ‘greater privatisation’.