[Cost expansion of the health system as a risk process]

Cost expansion in health care has been an issue of health policy for almost 20 years. Also after the health reform act of 1988 this has not changed remarkably. On the one side this may be due to pressure groups that block effective cost constraining politics. On the other side, however, scientific approaches are insufficient in explaining this phenomenon. Models of health economics often assume a one-sided cost/benefit-rationality of the health care sector. Also sociological attempts that emphasize the "Eigen"-rationality of the health system frequently cut short the problem for instance as "Selbsthypostasierierung". This paper deals with the question to what extent can cost expansion be regarded as a product of societal context conditions. Using risk-theoretical and systems-theoretical approaches it is shown that the interaction of separated subsystems builds up a growing risk potential that comes out among other things as cost expansion. This includes the risk of crashes of the social structure which might result in the loss of generally equal access to health care.