[Health economy and health promotion -- self-responsibility for health?]

The social insurance systems in Germany are about to face radical changes, predominantly due to demographic developments. The solution might be an increasing self-responsibility of the population. The suitability of this health economical concept is to be verified for health insurance. The starting point of the health economic debate, discussing the issue of responsibility, is its description, and therefore the health of populations and the fundamental determinants for the maintenance of health and for illness. This is followed by a theoretical health economic discussion on the question whether insurants and patients are suitable market partners shoulder the responsibility transferred to them. The description of empiric evidence of the effects of co-payment questions the concept of self-responsibility and finally leads to discussing the individual versus social responsibility for health and illness.