22
istics of the insured population, including morbidity (from 2007), thus reducing risk selec-
tion of sickness funds and strengthening the solidaristic character of the SHI (Brandhorst
2003: 218). With regard to medication, a number of reform acts were enacted - after budg-
ets for pharmaceuticals and rules concerning regress of doctors had been lifted - in order to
control price hikes by other means (see for details Hartmann 2003: 266ff.). Since 2003, the
2004 Health Care Modernization Act (GMG) and some subsequent reforms strengthened
the pace of privatising costs, but also introduced some innovations.19
3.4 General Patterns of Change in Major Programmes
To conclude this section, I will attempt to identify some general patterns of change from the
early 1970s to the present. Labour market policy and especially unemployment protection
underwent a continuous series of cuts that started off moderately in the 1970s, gained speed
during the 1980s, with instances of selective expansion towards the end of the decade. The
1990s saw first an intensification of active labour market policy followed by further cur-
tailments and tightening of eligibility rules. After 1998, the trend towards cost-containment
and restricting access to benefits continued, but, most importantly, the general approach to
labour market policy became more focussed on activating job-seekers. With the Hartz-
commission’s work, the different elements of labour market policy were questioned and
generated reform activity which culminated in a structural reform that merged unemploy-
ment assistance and social assistance and intended to change demands on job-seekers and
job centres alike. All in all, after three decades of cost-cutting and gradual tightening of
access, the policy field saw some reforms that went beyond these measures, introducing an
element of activation (and thus recommodification) and changing existing benefit struc-
tures.
The development of old-age pensions followed a similar pattern. After a last spell of expan-
sion in the early 1970s, pensions experienced continuous cuts in levels and annual adjust-
ments with contributions rising until and including the 1990s. In the course of this devel-
opment, the policy instruments used to contain the rise of pensions became ever more ex-
tensive, reflecting also the realization of the beginning demographic stress on the statutory
pension scheme. After 1998, the mix of cost-containment and increasing revenues briefly
continued, but it was punctuated in 2001 by a structural reform that introduced a privately
financed pillar of old-age provision and replaced the goal of preserving pension levels with
19 The GMG, on the one hand, reduced the benefit catalogue, increased co-payments including the much-
discussed quarterly flat-rate charge for seeing a doctor (Praxisgebühr) and increased the share of the
contribution rate paid by employees by 0.5 per cent. On the other, it reinforced family doctor schemes,
strengthened patients’ rights by including their associations in the major self-governance venue, the Fed-
eral Commission (Gemeinsamer Bundesausschuss), and introduced an independent Institute for Quality
and Efficiency. During late 2004, one controversial measure of the GMG, which would have excluded
dental replacements from the SHI, was repealed: in return for re-inclusion in the SHI catalogue, the in-
sured had to accept an increase in contributions by 0.4 percent (Bandelow forthcoming, 2007).