Competition between "Public Health Funds" : theory and Experiences from Germany and Switzerland

The introduction of competition between public insurers within the polish system of social health insurance, announced by the Ministry of Health Ewa Kopacz, is not a new idea. It raises doubts not so much about the potential possibility of using the instrument of competition for increasing the efficiency of the system but much more about the preparation of the system for such a constitutive change. Competition between public insurers works quite well in the social health insurance system in Germany and Switzerland. The experiences from these systems as well as the theory of health insurance economics show us that there are some preconditions that have to be met in order to realize the positive results of competition. In the first place, the insurers must want to compete. Secondly, they must have instruments for competition. And thirdly they must be kept from developing the risk selection in the form of cream skimming. Showing the constitutive value and character of public insurers’ competition the author of the article analyses the practical implications of the three mentioned preconditions and their realization in the German and Swiss health systems