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(in terms of their competences); a cautious correction of supply-side structures and incen-
tives for care providers (regarding, for instance, the remuneration of doctors and the budget-
ing of their services); and a trend towards the privatization of health care costs via co-
payments (Rosenbrock/Gerlinger 2004:247f.). During the 1980s, the early involvement of
interest groups in reform processes foreclosed the introduction of changes of incentives for
care providers, which had been on the policy agenda since 1985 (Bandelow/Schubert 1998:
117) The 1988 Health Care Reform Act (GRG) was intended to go further than mere cost-
containment, but it was substantially watered down in the process (Webber 1989). From
1992 until 1998, the government strategy changed, notably because the failure of the GRG
had made visible the limits of traditional cost-containment. The 1992 Health Care Structural
Reform Act (GSG) marked the beginning of a shift in health policy that would continue to
be felt until the present. The focus on stable contribution rates was strengthened and backed
by the introduction of sectoral budgets for expenditures and new steering instruments were
either introduced or extended in order to change the incentives of stakeholders (free choice
of sickness fund, introduction of budgets, more privatization of health care costs from 1996
onwards): this combination amounts to a ‘paradigmatic change in health care policy’
(Rosenbrock/Gerlinger 2004: 249f.). While the GSG introduced the most far-reaching
changes and which was adopted still in consensus between the two major German parties,
from 1995 the health care consensus broke down, and the later reforms of the period (in
1996 and 1997) were adopted against the will of the SPD opposition. Towards the end of
the Kohl period, the focal point of reforms switched from health care providers to the in-
sured and, to some extent, to sickness funds (Brandhorst 2003: 213).
3.3 The Red-Green Coalition (1998-2005): Cost-Containment and
Structural Change
Evaluations and interpretations of the Red-Green coalition often focus on the question
whether it stood for continuity or discontinuity of policy and whether its course in social
policy-making was particularly social-democratic in character. While the coalition itself
(both towards the end of its first term in 2002 and its second term in 2005) issued positive
self-evaluations in terms of having reached its social policy goals, outside evaluations were
less positive about their policy legacy. On the one hand, critics from the left (including the
left wing of the SPD and trade unions) diagnosed their work as a ‘neo-liberal tax and wel-
fare state reform project’ in order to secure Germany’s status as an economic location. On
the other hand, more business-related circles detected continuity of an ambitious social pol-
icy including high social contributions, a high social expenditure/GDP ratio and high-
standard social policy and labour law regulations: this view identified an urgent and unful-
filled need for reforms under the Red-Green coalition (Reformstau), comparable with the
immobility of the latter years of the Kohl government. While probably neither of these
views correctly characterizes Red-Green social policy making, it is more fruitful to point
out those instances of reforms which were in line with what could be expected from a SPD-
led government and those which constituted a break (Schmidt 2005: 113). The first reforms