Back to Europe: back to Bismarck?

Since 1989 there have been enormous changes in all aspects of health policy, and the Former Socialist Economies (FSEs) are facing similar challenges. The general restructuring of politics and economies has resulted in two leading orientations in the transformation of health care systems: the separation of funding and service provision from the state, and the separation of funding and service provision from each other. Many FSEs have already passed legislation establishing a sickness insurance system under a single national funding institution, or a combination of compulsory and voluntary insurance, or a system involving private sector insurance companies in generating compulsory or voluntary health care funding. Due to the peculiarities and specific features of the German health care system, the uncritical intention to implement the "Bismarck model" in the FSEs faces several problems. These can be summarized in one main point: the relative stability of the German health care system, which may be attractive to the FSEs, is based on economic prosperity and on a strong ability to assert the will of the central state institutions: these preconditions are not present in the FSEs.