Konvergenz der Gesundheitssysteme in der Europäischen Union

 

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Zusammenfassung

Ziel: Ökonomische Konvergenz ist ein erklärtes politisches Ziel der EZ. Im Gesundheitsbereich ist dies nicht der Fall; jedoch wird auch hier Konvergenz vermutet. Der Beitrag erschließt ökonomische Fragen der Konvergenz der EU-Mitgliedstaaten im Gesundheitsbereich. Methoden: Es werden Definitionen der Konvergenz und ihr Verhältnis zu gesundheitspolitischen Zielen erarbeitet; dabei gehen Erfahrungen aus der ökonomischen Konvergenzdiskussion ein. Auf Basis von Literaturreviews, theoretischen Analysen und empirischen Betrachtungen werden für den Gesundheitsbereich vier Zugänge zur Konvergenz untersucht: einkommensbedingte Konvergenz der Gesundheitsausgaben, Konvergenz von Gesundheitssystemen, gesundheitspolitische Konvergenz und handelsbedingte Konvergenz. Ergebnisse: Die Konvergenz des Pro-Kopf-Einkommens ist eine wesentliche Determinante der Konvergenz der Pro-Kopf-Gesundheitsausgaben. Für heutige EU-Mitgliedstaaten konvergierten diese und andere monetäre Indikatoren über die letzten Jahrzehnte. Indikatoren des Versorgungsprozesses divergierten zum Teil. Einige Studien weisen auf eine Konvergenz gesundheitspolitischer Maßnahmen. Das Volumen der grenzüberschreitenden Versorgung ist derzeit zu gering, um Konvergenz bestimmen zu können. Zu den gut handelbaren Gütern gehören patentgeschützte Arzneimittel; bezüglich dieses EU-Marktes wird kontrovers diskutiert, ob die bestehende Preisdifferenzierung eine effiziente Lösung darstellt. Schlussfolgerungen: Konvergenz im Gesundheitsbereich ist empirisch bislang vor allem ein monetäres Phänomen, gesundheitspolitisch eine plausible Hypothese, handelspolitisch ein Streitpunkt und forschungspolitisch ein Zukunftsthema.

Convergence of Health Systems in the European Union

Aim: In the EU, economic convergence is a declared political goal. This is not the case in the health sector. However, convergence in this sector is frequently suspected. The contribution explores economic issues in the convergence of EU member states in the health sector. Methods: Definitions of convergence as well as the relationship with health policy goals are elaborated. This includes experiences from the discussion on economic convergence. Based on literature review, theoretical reasoning and empirical analysis, four topics in convergence in the health sector are investigated: income-related convergence of health care expenditure, convergence of health systems, convergence in health policy and trade-related convergence. Results: The convergence of per-capita income is a major determinant of the convergence of health care expenditure. These and other monetary indicators have converged for current EU member states over the last decades. Indicators of the health care process in part have diverged. Some studies point towards convergence in health policy measures. The volume of cross-border health care is currently too small to determine convergence. Patent-protected drugs are easily tradable goods; referring to the respective EU market, there are controversial arguments whether or not the existing price differentiation is an efficient solution. Conclusions: Convergence in the health sector so far is empirically mainly a monetary phenomenon, in terms of health policy a plausible hypothesis, in terms of trade policy an issue of debate, and in terms of research policy a future topic.

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Prof. Dr. Reiner Leidl

Universität Ulm
Abteilung Gesundheitsökonomie

Postfach
89069 Ulm