The life expectation of a girl born in Germany in 2060 is seven years longer than the expectation in 2009 with 89.2 years. The number of people with an age over 65 years in Germany will likely increase from today – nearly 17 million – to around 22 million in 2060. A reason for this are medical improvements and a higher awareness of health. On the other side the birth-rate in Germany decreases continuously since 1960 with a state in 2011 of 1.36 children per woman. If this development will go on, the population in Germany will decrease over the next 40 or 50 years from today 80 million to 65 million, round about 20%.
This trend implies many challenges for all actors of the health system: How will people with old-age diseases or several chronicle problems be served and who will do that? Which approaches exist with respect to prevention, care and health accommodation of old people? How could the increased health services be financed by shrinking population which is able to work?
The average expenditure on health per capita in 2011 was 3.100 € per year. But for people over 85 years the costs each year are 15.000 €, nearly the fivefold of average. It is estimated that the costs for health insurances in 2060 will be 309 billion € per year, an increase of 95% compared to 2010.
The German health insurance system have to prepare for this scenario of high costs. The most intuitive approach to handle with this, is to start building a reserve fund. In cause of rising economy with many premium payer of health insurances, the reserve was estimated in 2012 at round about 16 billion €. But the problem is that the legal foundation in Germany is doesn’t consider to build reserve funds in health sector to prepare for future challenges. It is likely that this fund will be reduced in the next years by paying premiums back to insured person. Faced by this demographic development it should be useful to enable a further increase of reserves by changes in law.
Other approaches are reforms which intend to affect the effectiveness of the health system in general. This implies to achieve a low cost performance with an individual, successful treatment of patients. From the economic crisis in 2008 and the pressure to reduce costs in health sector, several policies could be observed. One approach is to link payments to improved performance to realize efficiency gains and contain costs. Useful could also be to restructure the Ministry of Health with implementing new IT systems to enhance logistics. Further the hospital sector could be a source of improvements and lower costs. A focus on outpatient care or investments in primary care could probably lower expended resources.
In recent years many reforms and political decisions smooth the way for cost-efficiency in German health system. But even with recognition of this positive development, an increase of premium rate for health insurances to 25% seems optimistically (today 15.5%), what is hardly to implement. To find a sustainable solution to overcome the demographical change is one of the major challenges of Germany in the future.
Alexander Max #1575
 Source: Federal Statistical Office of Germany
 See a report from „tagesschau.de“ from 02/13/2012
 Compare „Health policy responses to the financial crisis in Europe” from Mladovsky, Srivastava, Cylus, Karanikolos, Evetovits, Thomson and McKee (2012)
 See „Prognose des Beitragssatzes in der gesetzlichen Krankenversicherung“ from Dr. Frank Niehaus