[The historical development of the German health care system and respective reform approaches]

Starting with the 19th century, the following article provides a short overview on the reform history of health care in Germany. The focus is on the influence of predominant societal values, structures and medical concepts as well as pressing social problems on the development of the German social insurance system. As a consequence of industrialization, the 19th century was shaped by the impoverishment of a large part of the population. Domestically pressured by the growing organization of the workforce, the first nationwide health insurance was founded in 1883. After this, national associations of physicians were established to counterbalance the dominating position of the health insurance companies. After the abolition of self-government during the period of National Socialism, health politics in western Germany after 1945 was shaped by medical practices run by individual physicians and free self-government by organizations and corporations. Since the 1980s, on the one hand, the self-determination and responsibility of patients has been growing. On the other hand, health care is increasingly influenced by the standardization of medical processes and products and evidence based decision-making processes. Today the health care sector is perceived as a stand-alone economic sector, in which the patient as a consumer is becoming a central figure. Overall it is outlined that the health care sector was less influenced by the conceptions of medical and other health care professionals, but it was shaped by the economic, political and societal context and the resultant concepts. This is still valid today.