The following extract from Germany’s Federal Agency for Civic Education, written in German and translated into English using Google Translate, provides the historical context for the Health Structure Act of 1992.
The Health Structure Act of December 21, 1992, comes into force for the most part. It is intended to stop the avalanche of costs in the health care system, which is in a severe financial crisis (“immediate brake”). For this reason, expenditure on service providers (doctors, dentists, hospitals, pharmaceutical manufacturers, pharmacists, masseurs, physiotherapists, etc.) is budgeted: it must not increase more than the contributory incomes of the statutory health insurance funds over the next three years. The fees for prosthetic, orthodontic and dental services will be reduced by ten and five percent respectively. The costs for medicines and remedies must also be budgeted and thus reduced. The principle of cost recovery no longer applies to hospitals; it is being replaced by market-based incentives (performance-oriented fixed prices) and demand planning. The licensing of new statutory health insurance doctors and dentists in oversupplied regions will be restricted. Insured persons have to pay increased co-payments for hospitals, cures, expensive medicines and complex dentures. Hardship regulations are intended to cushion these burdens socially. The most comprehensive reform of statutory health insurance since 1945 was initiated by the new Health Minister Horst Seehofer (CSU). It met with resistance, especially from doctors, dentists, dental technicians and pharmacists.