{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T11:09:10Z","timestamp":1788865750403,"version":"build-2803163510"},"reference-count":36,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T00:00:00Z","timestamp":1785283200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Planning &amp;amp; Management"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>This article examines the cost\u2010effectiveness of the German healthcare system from the perspective of statutory health insurance (SHI). Using data for 2011\u20132014\u2014the most recent period for which consistent national inputs are available\u2014we compare a marginal, system\u2010wide cost\u2010effectiveness ratio with the cost\u2010effectiveness of newly approved cancer drugs. The analysis indicates that the German healthcare system incurred costs per life\u2010year gained that were broadly comparable to the incremental cost\u2010effectiveness ratios reported for many new cancer drugs. Sensitivity analyses varying the attribution of mortality reduction to healthcare do not materially alter this comparison. Although evidence of overuse and inefficiency in the German healthcare system is documented across multiple sectors, the available evidence does not clearly identify a single domain sufficiently large to explain the aggregate pattern. This raises the hypothesis that inefficiency may be diffuse, or that structural features common to high\u2010income health systems\u2014such as diminishing marginal returns to health spending\u2014play an important role. While the empirical estimates rely on data from roughly a decade ago, subsequent trends in treatment costs and life expectancy provide little indication that the underlying tension has dissipated. The findings highlight the need for more systematic cost\u2010effectiveness analysis across sectors, alongside rigorous evaluation of reforms and consideration of institutional and political constraints affecting implementation.<\/jats:p>","DOI":"10.1002\/hpm.70108","type":"journal-article","created":{"date-parts":[[2026,7,29]],"date-time":"2026-07-29T08:23:41Z","timestamp":1785313421000},"page":"1108-1115","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Efficiency of the German Healthcare System: Some Puzzling Findings"],"prefix":"10.1002","volume":"41","author":[{"given":"Afschin","family":"Gandjour","sequence":"first","affiliation":[{"name":"Frankfurt School of Finance &amp; Management  Frankfurt Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,29]]},"reference":[{"key":"e_1_2_11_2_1","volume-title":"Health at a Glance: Europe 2022: State of Health in the EU Cycle","author":"OECD\/European Union","year":"2022"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10273-012-1362-7"},{"key":"e_1_2_11_4_1","unstructured":"Bertelsmann Stiftung \u00dcberversorgung \u2013 eine Spurensuche (2019) https:\/\/www.iges.com\/kunden\/gesundheit\/forschungsergebnisse\/2019\/ueberversorgung\/index_ger.html#:~:text=Die%20IGES%2DRecherchen%20zeigen%20ferner auch%20%C3%B6konomische%20Zw%C3%A4nge%20und%20Anreize."},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40258\u2010023\u201000803\u2010x"},{"key":"e_1_2_11_6_1","article-title":"Avoidable Mortality: Oecd\/Eurostat Lists of Preventable and Treatable Causes of Death (November 2019 Version)","author":"OECD; European Commission, Eurostat","year":"2019","journal-title":"Eurostat (Directorate F: Social statistics)"},{"issue":"1","key":"e_1_2_11_7_1","first-page":"43","article-title":"Analyse der AMNOG\u2010Erstattungsbetr\u00e4ge im europ\u00e4ischen Preisumfeld","volume":"22","author":"Hammerschmidt T.","year":"2017","journal-title":"Gesundh \u00d6kon Qual Manag."},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010021\u201007327\u2010x"},{"key":"e_1_2_11_9_1","unstructured":"A.Storm.AMNOG\u2010Report 2017 Nutzenbewertung von Arzneimitteln in Deutschland. DAK\u2010Gesundheit(2017)."},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2019.08.005"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2023.115909"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1586\/erp.11.1"},{"key":"e_1_2_11_13_1","unstructured":"S.Bundesamt Entwicklung der Lebenserwartung in Deutschland (2026) https:\/\/www.destatis.de\/DE\/Themen\/Gesellschaft\u2010Umwelt\/Bevoelkerung\/Sterbefaelle\u2010Lebenserwartung\/sterbetafel.html."},{"key":"e_1_2_11_14_1","unstructured":"Eurostat Healthy Life Years by Sex (From 2004 Onwards) accessed on July 3 2024 https:\/\/ec.europa.eu\/eurostat\/databrowser\/view\/hlth_hlye\/default\/table?lang=en."},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524\u20104733.2007.00185.x"},{"key":"e_1_2_11_16_1","volume-title":"\u00dcberversorgung\u2014eine Spurensuche","author":"Westrick M. G.","year":"2019"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1787\/9789264266414-en"},{"key":"e_1_2_11_18_1","unstructured":"Commonwealth Fund(2017) https:\/\/www.commonwealthfund.org\/publications\/journal\u2010article\/2017\/feb\/combating\u2010overuse\u2010and\u2010underuse\u2010health\u2010care."},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1002\/hpm.2247"},{"key":"e_1_2_11_20_1","article-title":"Patentarzneimittel: Hohe Gewinnspannen der Pharmaunternehmen bei geringem Beitrag zur Versorgung","volume":"16","author":"Wissenschaftliches Institut der AOK","year":"2020","journal-title":"Pressemitteilung"},{"key":"e_1_2_11_21_1","volume-title":"Generika in Zahlen: Markt 2024","author":"Pro Generika e.V","year":"2025"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthpol.2018.08.009"},{"key":"e_1_2_11_23_1","unstructured":"Pro Generika.Marktdaten Generika 1 bis 3. Quartal (2022) https:\/\/www.progenerika.de\/wp\u2010content\/uploads\/2025\/04\/Marktdaten\u2010Generika_Quartal\u20101\u2010bis\u20103\u20102022.pdf."},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-662-66041-6"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1787\/4dd50c09-en"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.zefq.2022.09.004"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913\u2010022\u201008956\u20106"},{"key":"e_1_2_11_28_1","unstructured":"S.Bundesamt Zahl der Krankenhaus\u2010Behandlungen 2022 um 13 4% unter Vor\u2010Corona\u2010Niveau. Pressemitteilung Nr. 386 vom 28 (2023) https:\/\/www.destatis.de\/DE\/Presse\/Pressemitteilungen\/2023\/09\/PD23_386_231.html."},{"key":"e_1_2_11_29_1","unstructured":"Medizinischer Dienst Bund Behandlungsfehler\u2010Begutachtung der Gemeinschaft der Medizinischen Dienste Jahresstatistik 2022 (2023) https:\/\/md\u2010bund.de\/fileadmin\/dokumente\/Pressemitteilungen\/2023\/2023_08_17\/PK_BHF_2022_Jahresstatistik.pdf."},{"key":"e_1_2_11_30_1","unstructured":"Medizinischer Dienst Bund Behandlungsfehlerbegutachtung 2022: Immer wieder die gleichen Fehler (2023) https:\/\/md\u2010bund.de\/presse\/pressemitteilungen\/neueste\u2010pressemitteilungen\/behandlungsfehlerbegutachtung\u20102022\u2010immer\u2010wieder\u2010die\u2010gleichen\u2010fehler.html."},{"key":"e_1_2_11_31_1","unstructured":"VDEK Daten Zum Gesundheitswesen. Stand (2023) https:\/\/www.vdek.com\/presse\/daten\/b_versicherte.html."},{"key":"e_1_2_11_32_1","volume-title":"Health Systems Financing: The Path to Universal Coverage","author":"World Health Report","year":"2010"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.3310\/hta19140"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/hec.3946"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40273\u2010024\u201001441\u20104"},{"key":"e_1_2_11_36_1","article-title":"Lauterbach: Geben Menschen ein Instrument, um besser informiert die richtige Klinik zu w\u00e4hlen","volume":"19","author":"Bundesministerium f\u00fcr Gesundheit","year":"2023","journal-title":"Oktober"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hlpt.2022.100688"}],"container-title":["The International Journal of Health Planning and Management"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hpm.70108","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hpm.70108","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hpm.70108","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T10:23:58Z","timestamp":1788863038000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hpm.70108"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,29]]},"references-count":36,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["10.1002\/hpm.70108"],"URL":"https:\/\/doi.org\/10.1002\/hpm.70108","archive":["Portico"],"relation":{},"ISSN":["0749-6753","1099-1751"],"issn-type":[{"value":"0749-6753","type":"print"},{"value":"1099-1751","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,29]]},"assertion":[{"value":"2025-10-28","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-29","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}