Prof. Wolfgang Greiner, Dr. (Bielefeld)

Curriculum vitae

Prof. Dr. Wolfgang Greiner, born 1965, heads the health economy and health management faculty at Bielefeld University. Previous to his appointment he had worked as chief research officer at the research unit for health economy and health application research a joint facility of the Hannover university and the Hannover Medical School (MHH). His doctorate 1998 dealt with the cost-benefit-analysis within the healthcare system with the example of kidney and liver transplantation. Within his habilitation 2004 he discussed the health economic aspects of disease management. He is author of numerous articles in books and journals and managing editor of the “European Journal of Health Economics”. 1999 he was chosen for the EuroQol-Foundation board in Rotterdam. Furthermore he belongs to the scientific board of advisers of the Techniker Krankenkasse (technician health insurance), the health insurance DAK as well as to the supervisory board and executive committee of the hospital Klinikum Region Hannover GmbH. He is representative chairman of the supervisory board of the medical center Medizinisches Zentrum für Gesundheit Bad Lippspringe GmbH. Prof. Greiner belonged to the scientific board of advisers for the restructuring of the risk structure compensation within the statutory health insurance from May 2007 until March 2008. Furthermore he is a member of the Council of Experts for the Assessment of the Development within the Healthcare System at the Federal Ministry or Health.

Prof. Greiners scientific focus is the field of health service evaluation, quality of life research, health technology assessment, risk structure compensation as well as disease management. He is a visiting lecturer at the universities of Magdeburg, Bern, Berlin (Charité) and Lüneburg und honoree of the Austrian award for health economy, the science award of the Hannover university as well as the Medvantis-research award.

Contact: Prof. Dr. Wolfgang Greiner, Universität Bielefeld, Fakultät der Gesundheitswissenschaften, Gesundheitsökonomie und Gesundheitsmanagement, Universitätsstraße 25, 33615 Bielefeld, Tel.:

0521 106 6989; Fax: 0521 106 156989; E-mail: wolfgang.greiner(at)uni-bielefeld.de

Interview

“We have to determine minimum quality standards” is the belief of health economist Prof. Dr. Wolfgang Greiner about the cost development within the healthcare system, higher rates of co-payment and how to find a consent about the question what a solidary system should finance.

The health insurances expect billions in deficits. Will the contributions increase further, Professor Greiner?
 
Greiner: At present we register due to the positive economic situation even surpluses among the health insurances. However, long-term rising additional contributions for the health insurances are expected, in fact already starting in 2013. The current general contribution rate will no longer be sufficient in this case.
 
Today surpluses and tomorrow higher contributions. How come?
 
Greiner: The demographic development in Germany and the technical progress lead mandatorily to the fact that the cost development within the healthcare system increases stronger than the general price level. Therefore, on the current care level rising contributions are expected, which in the meantime is also recognized by the health politics as a fact.
 
Which impact does this development have on the quality of medical care?
 
Greiner: The impact on the quality of medical care in this case also are rather subtle. Within a sector with poor competition like the health economy it is almost impossible for the suppliers to distinguish themselves as quality suppliers. Even though the insurances are presented with expansion of optional benefits and additional contracts with the providers. Currently they are hardly used by insured persons. To keep up with the current quality level, long-term we cannot get around the definition of minimum quality standards, e.g. concerning the coverage of care within rural areas or also the quality of results in hospitals. Within a competitive system this would constitute the minimum level, which could be exceeded by the individual insurances if applicable by respective justified higher prices.
 
Do any limitations of the benefits catalogue of the insurances have to be expected?
 
Greiner: It is a political question, if the contribution increase is connected at the same time with declining benefits. This question among other things will in future depend on the height of the social compensation for people who cannot afford additional contributions rising any longer. The tax financing will reach its limits at some point and one has to think about at what time and on which level of evidence, innovations in particular, may find a direct way into the benefits catalogue.
 
Does politics have the right answer for solving the financing problems, e.g. the health fund?
 
Greiner: The health fund does not provide the least answer to pressing questions, which are currently posed, facing the demographic development and medical progress within the healthcare system.
 
What was the purpose of the health fund after all?
 
Greiner: The health fund merely caused the unification of contribution rates.The initial competition was rather minimized instead of increased. Furthermore, the politics did not have the courage to accept additional contributions as part of a normal statutory health insurance (SHI)-financing because all insurances, which had to raise the respective contributions, were branded as being uneconomic right from the start. Any additional contributions cannot rid themselves from that stigma, so this eventually has to lead to the fact, that the question of financing has to be thought of in a totally new way dismissing old patterns like Bürgerversicherung (universal health care) and health premium.
 
What is your recipe against the financing problem?
 
Greiner: First of all, the current legal position of health insurances as a public legal entity with a constitutional status is an anachronism, which does not fulfill the current conditions as well as the expectations on health insurances as a business entity. Health insurances as well as private health insurance companies should be given more freedom to offer solidarily financed as well as actuarial calculated tariffs to complement each other as it is done in the Netherlands.
 
Does this lead up to the so-called Bürgerpauschale?
 
Greiner: We already proposed the concept of a subsidiary so-called Bürgerpauschale years ago, admittedly all citizens in it are obliged to pay into a funded system, the rate of co-payment would be dependent on the level of income. This would lead to the fact that higher incomes with higher co-payment rates have their own additional insurance needs. This way the solidarity balance could be designed on a smaller expenditure level and also administratively significantly easier than it is now designated.
 
You already mentioned it earlier. The costs are boosted by medical innovations. How is it possible to accomplish a consent about what a solidary system should finance?
 
Greiner: We have been active in the field of health economic evaluations in Bielefeld and Hannover for years. We compile and compare costs and benefits of innovations before and during the market entrance. This so-called “value based approach” is the only rational long-term answer to the vast number of medical innovations within a collective financed system.
 
How does such a “value based approach” work?
 
Greiner: The basic idea is that the value of an innovation is decided on a scientific basis. Therefore all available study results are used and decisions to enter the benefit system are only made if the new services when their additional costs face a proper additional benefit. In other countries this concept has already been established  for years and proved to be successful. However, there is also a bigger social consent about the fact that resources are not unlimited within the healthcare system and therefore selection decision is necessary, including innovations. They should be made on the basis of the available scientific data and not through the activities of lobby organizations or other irrelevant influences.
 
Interview: Beatrice Hamberger Prof. Dr. Wolfgang Greiner is head of the health economy and health management faculty at the Bielefeld University and member of the council of experts for the assessment of the development within the healthcare system at the Federal Ministry of Health.

“In the future the individual ambulant practices belong to the past" Five questions for the health economist Prof. Dr. Wolfgang Greiner about the future of the German healthcare system

Professor Greiner, as a health economist you are thinking at least one step ahead. Where do you picture the healthcare system in 15 years?
 
Greiner: Because the basic economic laws are also valid in future healthcare systems, I am deeply convinced that the system will be more competitive in 15 years than it is today with a higher rate of privately financed demand. However, Germany also has a long and good tradition to obtain an equal general high care level for the class of population which couldn't afford a health insurance in a purely privately financed system. For those people the fiscal social compensation will have a higher significance than today.
 
How do you rate the mix of private funding and fiscal social compensation?
 
Greiner: From an economical point of view this is to be welcome. Because the current redistribution is hidden in the statutory health insurance system, in which insured people profit, who economically could even afford to take care of their healthcare insurance on their own.
 
Will the structures be preserved as they are currently within the healthcare system?
 
Greiner: Based on the experiences in other countries I believe that we have to reroute from the strong centralism, which we can currently see within the decision-making structures in Germany, to a stronger regionalization. In this course the regions -and less the countries as envisaged today - will take over more responsibility, also with a financial character, for the health care and the accessibility of service providers.
 
And the often predicted interdisciplinary networking?
 
Greiner: Indeed, bigger units will merge among the service provision also across sectorial boundaries. This means that the individual hospital and the individual ambulant practices will belong to the past in the future. A higher quality with a further acceptable cost level is developing from a stronger bundling and networking of such structures.
 
Last but not least: Will the healthcare be more international in the course of globalization?
 
Greiner: I am convinced that the health care will internationalize more strongly, what we can already see currently rudimentarily within the pharmaceutical sector, like e.g. at the mail-order pharmacies from the Netherlands. Additionally bigger hospital corporations rely on patients abroad for the occupancy of the required capacities. And if the health insurances are permitted to do so, they also will enter contracts with foreign service providers in the out-patient or in-patient field, at least within the borderland.
 
Interview: Beatrice Hamberger Prof. Dr. Wolfgang Greiner is head of the health economy and health management faculty at the Bielefeld University and member of the council of experts for the assessment of the development within the healthcare system at the Federal Ministry of Health.