Health economics in Germany can be considered as a collective term for all activities that have anything to do with health in this country. This interpretation done by Andreas Goldschmidt in 2002 seems, however, very generous due to several overlaps with other economic sectors. A simple outline of the health sector in three areas provides an "onion model of health care economics" by Elke Dahlbeck and Josef Hilbert from "Institut Arbeit und Technik (IAT)" at the University of applied sciences Gelsenkirchen: Core area is the ambulatory and inpatient acute care and geriatric care, and health administration. Around it is located wholesale and supplier sector with pharmaceutical industry, medical technology, healthcare, and wholesale trade of medical products. Health-related margins are the fitness and spa facilities, assisted living, and health tourism.
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According to this basic idea an almost totally regulated health care market like in the UK were not very productive, but also a largely deregulated market in the United States would not be optimal. Both systems would suffer concerning sustainable and comprehensive patient care. Only a hybrid of social well-balanced and competitive market conditions created a relevant optimum. Nevertheless forces of the healthcare market in Germany are often regulated by a variety of amendments and health care reforms at the legislative level, especially by the "Social Security Code" (Sozialgesetzbuch- SGB) in the past 30 years.
Importance in Germany
Health care in Germany including its industry and all services is one of the largest sectors of the German economy. Direct inpatient and outpatient care equivalent to just about a quarter of the entire 'market' - depending on the perspective. A total of 4.4 million people working in this, that means about one in ten employees in 2007 and 2008. The total expenditure in health economics was about 287.3 billion Euro in Germany in 2010, equivalent to 11.6 percent of gross domestic product (GDP) this year and about 3.510 Euro per capita.
Pharmaceutical drugs
The pharmaceutical industry plays within and beyond direct health care a major role in Germany. Expenditure on pharmaceutical drugs is almost half as high as those for the entire hospital sector. Pharmaceutical drug expenditure grew by an annual average of 4.1% between 2004 and 2010. Such developments caused since the 1980s numerous health care reforms. An actual example of 2010 and 2011: First time since 2004 the drug expenditure fell from 30.2 billion Euro in 2010 to 29.1 billion Euro in 2011, i. e. minus 1.1 billion Euro or minus 3.6%. That was caused by restructuring the Social Security Code: manufacturer discount 16% instead of 6%, price moratorium, increasing discount contracts, increasing discount by wholesale trade and pharmacies.
'First' and 'second' health market
In Germany, all privately financed products and services for health are assigned as part of the 'second health market'. Unlike the 'first health market' they are usually not paid by a public or private health insurance. Patients with public health insurance paid privately about 1.5 Billion Euro in this market segment in 2011, while already 82% of physicians offered their patients in their practices individual services being not covered by the patient's insurances; the benefits of these services are controversial discussed. Private investments in fitness, for wellness, assisted living, and health tourism are not included in this amount. The 'second health market' in Germany is compared to the United States still relatively small, but is growing continuously.