平成 年度医療経済研究機構自主研究事業

ᐔ ᚑ2 4ᐕ ᐲක ≮ ⚻ ᷣ ⎇ ⓥ ᯏ ᭴⥄ ਥ ⎇ ⓥ ੐ ᬺ24࠼ࠗ࠷ක≮㑐ㅪ࠺࡯࠲㓸‫ޣ‬2012 ᐕ ‫ޤ‬

ドイツ医療関連データ集࡮ ක≮㑐ㅪ࠺࡯࠲࡮ ක≮଻㓚೙ᐲ᭎ⷐ࡮ ක≮଻㓚ෳ⠨ᢥ₂࡮න⺆㓸ᐔᚑ 25 ᐕ 3 ᦬࠼ࠗ࠷ක≮଻㓚೙ᐲߦ㑐ߔࠆ⎇ⓥળ✬平成৻⥸⽷࿅ᴺੱ ක≮⚻ᷣ⎇ⓥ࡮␠ળ଻㒾⑔␩දળ年３月

25IHEPක≮⚻ᷣ⎇ⓥᯏ᭴

医療経済研究機構

表紙-ドイツ医療関連データ集-2012年版.indd 1

2013/06/04 15:54:20

平成 年度医療経済研究機構自主研究事業

ᐔ ᚑ2 4ᐕ ᐲක ≮ ⚻ ᷣ ⎇ ⓥ ᯏ ᭴⥄ ਥ ⎇ ⓥ ੐ ᬺ24࠼ࠗ࠷ක≮㑐ㅪ࠺࡯࠲㓸‫ޣ‬2012 ᐕ ‫ޤ‬

ドイツ医療関連データ集࡮ ක≮㑐ㅪ࠺࡯࠲࡮ ක≮଻㓚೙ᐲ᭎ⷐ࡮ ක≮଻㓚ෳ⠨ᢥ₂࡮න⺆㓸ᐔᚑ 25 ᐕ 3 ᦬࠼ࠗ࠷ක≮଻㓚೙ᐲߦ㑐ߔࠆ⎇ⓥળ✬平成৻⥸⽷࿅ᴺੱ ක≮⚻ᷣ⎇ⓥ࡮␠ળ଻㒾⑔␩දળ年３月25

IHEPක≮⚻ᷣ⎇ⓥᯏ᭴

医療経済研究機構

表紙-ドイツ医療関連データ集-2012年版.indd 1

2013/06/04 15:54:20ᧄ⺞ᩏ⎇ⓥߪ‫ߩ࠷ࠗ࠼ޔ‬ක≮଻㓚೙ᐲߦ㑐ߔࠆၮ␆࠺࡯࠲‫ߦ߮ࠄߥޔ‬ㄭᐕߩක≮೙ᐲᡷ㕟ࠍ߼ߋࠆᦨᣂᖱႎࠍ෼㓸ߔࠆߎߣࠍ⋡⊛ߣߒߡታᣉߒߚ‫ޕ‬࠼ࠗ࠷߅ࠃ߮ᣣᧄߩක≮೙ᐲߦ♖ㅢߒߚ᦭⼂⠪ߦࠃࠆᆔຬળࠍ⸳┙ߒ‫࠷ࠗ࠼ޔ‬ක≮଻㓚೙ᐲߦ㑐ߔࠆ⎇ⓥ߿࠺࡯࠲ࠍ෼㓸࡮ᢛℂߒ‫ߩߘޔ‬ᚑᨐࠍᧄႎ๔ᦠߣߒߡ߹ߣ߼ߚ‫ޕ‬ᆔຬળߩ᭴ᚑߪએਅߩㅢࠅߢ޽ࠆ‫ޕ‬࠼ࠗ࠷ක≮଻㓚೙ᐲߦ㑐ߔࠆ⎇ⓥળ㧔ᐳ㐳㧕 ࿯↰ ᱞผ㧔ᣧⒷ↰ᄢቇ໡ቇㇱᢎ᝼㧕㧔ᆔຬ㧕 㜞ᥓ ⧷ᄥ㇢ 㧔ஜᐽ଻㒾⚵วㅪวળℂ੐㧕↰ਛ ⠹ᄥ㇢ 㧔ጊญ⋵┙ᄢቇ␠ળ⑔␩ቇㇱᢎ᝼㧕ᐭᎹ ືᄦ㧔⑔␩ᧂ᧪⎇ⓥᚲ ઍ⴫㧕⥵ᯅ శବ㧔೨ ࿖᳃ஜᐽ଻㒾ਛᄩળ ⎇ⓥຬ㧕㧔ࠕ࠼ࡃࠗࠩ࡯㧕㗇↰ ବቁ㧔ෘ↢ഭ௛⋭᡽╷⛔᜝ቭઃᖱႎ᡽╷ᜂᒰෳ੐ቭቶ᡽╷ડ↹ቭ㧕ጊญ㜞ᔒ㧔ෘ↢ഭ௛⋭଻㒾ዪ㜞㦂⠪ක≮⺖㧕 㧔ᢘ⒓⇛‫ޔ‬ᚲዻߪᐔᚑ 25 ᐕ 3 ᦬⃻࿷㧕㧔੐ോዪ㧕ਛፉ ᳃ᕺሶ
᦯ㇱ ໪ሶ
㜞ਭ ⃍㖸⍫ญ ᕺ㧔ක≮⚻ᷣ⎇ⓥᯏ᭴ ਥછ⎇ⓥຬ㧕㧔ක≮⚻ᷣ⎇ⓥᯏ᭴ ਥછ⎇ⓥຬ㧕㧔ක≮⚻ᷣ⎇ⓥᯏ᭴ ⎇ⓥຬ㧕㧔ක≮⚻ᷣ⎇ⓥᯏ᭴ ⎇ⓥຬ㧕ᧄႎ๔ᦠߩ৻ㇱ߹ߚߪోㇱࠍ໧ࠊߕ‫ޔ‬ήᢿᒁ↪‫ޔ‬ォタࠍ⑌ߕࠆ

―i―࠼ࠗ࠷ක≮㑐ㅪ࠺࡯࠲㓸‫ޣ‬2012 ᐕ‫ޤ‬‫⋡ޝ‬ᰴ‫ޞ‬ࡍ࡯ࠫ1࠼ࠗ࠷࿖ౝߩᦨㄭߩേ߈࠼ࠗ࠷ක≮㑐ㅪ࠺࡯࠲‫ޣ‬2012 ᐕ5‫ޤ‬1. ੱญ࡮ੱญേᘒ

5

1-1㧕㕙Ⓧ࡮ੱญ࡮ੱญኒᐲ...................................................................................................................................... 6
1-2㧕ᐕ㦂㓏⚖೎ੱญផ⒖㧔ฦᐕ 12 ᦬ 31 ᣣ㧕 ...................................................................................................... 7
1-3㧕዁᧪ੱญផ⸘ ..................................................................................................................................................... 9
1-4㧕ᕈ೎ੱญផ⒖㧔2010 ᐕ 12 ᦬ 31 ᣣ⃻࿷㧕 ................................................................................................... 101-5㧕ੱญࡇ࡜ࡒ࠶࠼㧔2009 ᐕ 12 ᦬ 31 ᣣ⃻࿷㧕 ............................................................................................... 11
1-6㧕ᐕ㦂೎ᐔဋ૛๮㧔࠼ࠗ࠷ㅪ㇌౒๺࿖㧕 ........................................................................................................ 12
1-7㧕ᇕᆪ࡮಴↢࡮ᱫ੢ઙᢙ.................................................................................................................................... 13
1-8㧕ว⸘․ᱶ಴↢₸ߩផ⒖.................................................................................................................................... 14
1-9㧕ᐕ㦂㓏ጀ೎ᱫ੢ᢙ࡮ᱫ੢₸ߩផ⒖................................................................................................................ 15
1-10㧕ᱫ࿃೎ᱫ੢ᢙ ................................................................................................................................................. 16

2. ⚻ᷣᜰᮡ

19

2-1㧕 ࿖ౝ✚↢↥‫ޔ‬࿖᳃✚↢↥‫ޔ‬࿖᳃ᚲᓧ......................................................................................................... 20
2-2㧕 ઃടଔ୯‫ޔ‬࿖ౝ✚↢↥‫ޔ‬࿖᳃✚↢↥......................................................................................................... 21
2-3㧕 ᄬᬺ⠪ᢙ࡮ᄬᬺ₸ߩផ⒖ ............................................................................................................................ 222-4㧕 ৻⥸᡽ᐭ⽷᡽⾌⋡೎෼ᡰ ............................................................................................................................ 24
2-5㧕 ಽ㊁೎৻⥸᡽ᐭ⽷᡽ᡰ಴ផ⒖ .................................................................................................................... 26
2-6㧕 ೙ᐲ೎␠ળ଻㓚ᡰ಴ផ⒖ ............................................................................................................................ 27ෳ⠨㧕 ฦ࿖ߩ᡽ᐭߩᄢ߈ߐ .................................................................................................................................... 30

3. ක≮⾌31

3-1㧕 ක≮ߩ⒳㘃෸߮⽶ᜂ೎଻ஜක≮⾌㧔2010 ᐕ㧧࠼ࠗ࠷ㅪ㇌౒๺࿖㧕 .................................................... 32
3-2㧕 ଻ஜක≮ಽ㊁ߩ⾗㊄ߩᵹࠇ࿑㧔2010 ᐕ㧧࠼ࠗ࠷ㅪ㇌౒๺࿖㧕 ............................................................ 33
3-3㧕 ⛎ઃߩ⒳㘃೎଻ஜක≮⾌ߩᐕᰴផ⒖......................................................................................................... 343-4㧕 ౏⊛ක≮଻㒾ߩ㗄⋡೎⛎ઃ㗵෸߮᭴ᚑᲧߩផ⒖..................................................................................... 36ෳ⠨ 1㧕੺⼔଻㒾೙ᐲዉ౉೨ߩ㊀ᐲⷐ੺⼔ߦኻߔࠆ౏⊛ක≮଻㒾ߩ⛎ઃታ❣ ............................................... 38ෳ⠨ 2㧕ᣣᧄ‫ޔࠞ࡝ࡔࠕޔ‬EU ฦ࿖ߩක≮⾌ ........................................................................................................ 394. ∔∛㊄ᐶ414-1㧕 ∔∛㊄ᐶᢙផ⒖ ............................................................................................................................................. 42
4-2㧕 ක≮଻㒾⒳㘃೎ੱญ*㧔2011 ᐕ㧕 ............................................................................................................... 43
4-3㧕 ౏⊛ක≮଻㒾ߩട౉⾗ᩰ೎ⵍ଻㒾⠪ᢙߩផ⒖ .......................................................................................... 44― iii ―

4-4㧕 ౏⊛ක≮଻㒾ⵍ଻㒾⠪ߩᐕ㦂㓏⚖೎ಽᏓ㧖)㧔࠼ࠗ࠷ㅪ㇌౒๺࿖㧕 ..................................................... 454-5㧕 ౏⊛ක≮଻㒾ߩ⽷᡽෼ᡰߣ⾗↥ .................................................................................................................. 46
4-6㧕 ౏⊛ක≮଻㒾෼ᡰߩផ⒖.............................................................................................................................. 47
4-7㧕 ∔∛㊄ᐶ⒳㘃೎଻㒾ᢱ₸ផ⒖㧔ᐕ㑆ᐔဋ㧕 .............................................................................................. 48
4-8㧕 ᳃㑆ක≮଻㒾㧔ቢో଻㒾㧕ߩᡰ಴ផ⒖ ...................................................................................................... 49
4-9㧕 ౏⊛ක≮଻㒾ߦ߅ߌࠆᖚ⠪৻ㇱ⽶ᜂ৻ⷩ .................................................................................................. 504-10㧕౏⊛ක≮଻㒾ߩᖚ⠪৻ㇱ⽶ᜂផ⒖ߣ⃻⁁㧔ਥⷐ⛎ઃ㗄⋡㧕................................................................... 51

5. ౏⊛੺⼔଻㒾

57

5-1㧕 ౏⊛੺⼔଻㒾ߩ⛎ઃ᭎ⷐ............................................................................................................................. 58
5-2㧕 ౏⊛੺⼔଻㒾ߩㆡ↪⠪ᢙ෸߮⛎ઃታᣉ⁁ᴫ╬ ......................................................................................... 60
5-3㧕 ౏⊛੺⼔଻㒾ߩ⽷᡽෼ᡰ㧔1999 ᐕ㨪2011 ᐕ㧕 ....................................................................................... 61
5-4㧕 ᐕ㦂㓏⚖㧛੺⼔ᐲ࡮↵ᅚ೎౏⊛੺⼔଻㒾ߩ⛎ઃฃ⛎⠪ᢙ ..................................................................... 62
5-5㧕 ౏⊛੺⼔଻㒾ߦ߅ߌࠆ⛎ઃߩ⒳㘃೎෸߮੺⼔ᐲ೎ߦߺߚ⛎ઃฃ⛎⠪.................................................. 64

6. ක≮ឭଏ૕೙65

6-1㧕 ∛㒮ᢙ࡮∛ᐥᢙߩᐕᰴផ⒖......................................................................................................................... 66
6-2㧕 ∛㒮෸੍߮㒐㧛࡝ࡂࡆ࡝࠹࡯࡚ࠪࡦᣉ⸳ ................................................................................................. 67
6-3㧕 ∛㒮⸻≮⑼೎∛ᐥᢙߩᐕᰴផ⒖................................................................................................................. 68
6-4㧕 ∛㒮⸻≮⑼೎ᐔဋ࿷㒮ᣣᢙߩᐕᰴផ⒖ ..................................................................................................... 70
6-5㧕 ਥⷐ⸻ᢿ೎౉㒮ઙᢙ࡮࿷㒮ᣣᢙ㧔2009 ᐕ㧕*)......................................................................................... 72
6-6㧕 ∛㒮ߩ⚻⾌ 2009 ᐕ ..................................................................................................................................... 74ෳ⠨㧕 ∛㒮ߩ⚻⾌ .................................................................................................................................................... 75
6-7㧕 ዞᬺᒻᘒ೎කᏧᢙߩផ⒖............................................................................................................................. 76
6-8㧕 ኾ㐷⑼೎කᏧᢙ࡮ᱤ⑼කᏧᢙ࡮⮎೷Ꮷᢙߩᐕᰴផ⒖ ............................................................................. 77
6-9㧕 ኾ㐷⑼೎࡮ዞᬺᒻᘒ೎කᏧᢙ㧔2011 ᐕ 12 ᦬ 31 ᣣ㧕 ............................................................................ 78
6-10㧕 ᄾ⚂කᏧᢙ‫≮⸻ޔ‬ઙᢙ‫≮⸻ޔ‬ႎ㈽............................................................................................................. 79
6-11㧕 ∛㒮෸੍߮㒐㧛࡝ࡂࡆ࡝࠹࡯࡚ࠪࡦᣉ⸳ߩᓥ੐⠪ᢙ ............................................................................. 80
6-12㧕 ⮎ዪ෸߮⮎೷㑐ㅪᓥ੐⠪ᢙ㧔ฦᐕ 12 ᦬ 31 ᣣ㧕 ..................................................................................... 81

7. ⮎೷

83

7-1㧕 ౏⊛ක≮଻㒾ߦ߅ߌࠆಣᣇᢙߣක⮎ຠᄁ਄㜞ߩផ⒖㧔ᣥ᧲࠼ࠗ࠷ࠍ฽߻㧕...................................... 84
7-2㧕 ⮎ല⟲೎ಣᣇᢙ࡮ᄁ਄㜞㧔࠼ࠗ࠷ㅪ㇌౒๺࿖㧧2010 ᐕ㧕 .................................................................... 85
7-3㧕 ‫ޟ‬ක⮎ຠߦኻߔࠆ౏⊛ක≮଻㒾߆ࠄߩᡰ಴‫⵾⚳ᦨޟߣޠ‬ຠߚࠆක⮎ຠߩᄁ਄㜞‫ ޠ‬.......................... 88― iv ―࠼ࠗ࠷ක≮଻㓚೙ᐲ᭎ⷐ‫ޣ‬2012 ᐕ89‫ޤ‬1. ක≮଻㒾ߩⵍ଻㒾⠪90

1-1. ⵍ଻㒾⠪ߩ▸࿐ .............................................................................................................................................. 90
1-2. ⵍ଻㒾⠪ߩ඙ಽ .............................................................................................................................................. 90
1-3. ⵍ଻㒾⠪ߩ᭴ᚑ .............................................................................................................................................. 93

2. ක≮଻㒾ߩⵍ଻㒾⠪93

2-1. ∔∛㊄ᐶߩ⛔วౣ✬....................................................................................................................................... 93
2-2. 㐿᡼ဳߩ∔∛㊄ᐶߣ㐽㎮ဳߩ∔∛㊄ᐶ ....................................................................................................... 95
2-3. ฦ⒳∔∛㊄ᐶߦ߅ߌࠆⵍ଻㒾⠪ᢙߩᄌൻ ................................................................................................... 95
2-4. ∔∛㊄ᐶߩ▤ℂㆇ༡....................................................................................................................................... 96
2-5. ∔∛㊄ᐶߩㅪวળ .......................................................................................................................................... 97

3. ଻㒾⛎ઃ98

3-1. ଻㒾⛎ઃߩ⒳㘃ߣౝኈ................................................................................................................................... 98
3-2. ㆬᛯ࠲࡝ࡈߣࡏ࡯࠽ࠬ࡮ࡊࡠࠣ࡜ࡓ......................................................................................................... 103
3-3. ᖚ⠪৻ㇱ⽶ᜂߣߘߩ⽶ᜂシᷫភ⟎............................................................................................................. 105

4. ක≮ଏ⛎૕೙

105

4-1. ᄖ᧪⸻≮ ........................................................................................................................................................ 105
4-2. ౉㒮ක≮ߩ⛎ઃ ............................................................................................................................................ 108
4-3. ක⮎ຠߩ⛎ઃ ................................................................................................................................................ 110

5. ⸻≮ႎ㈽113

5-1. ଻㒾ක䋨ᄖ᧪⸻≮䋩䈱⸻≮ႎ㈽ ..................................................................................................................... 113
5-2. ∛㒮䈱⸻≮ႎ㈽............................................................................................................................................. 118

6. ක≮଻㒾ߩ⽷᡽120

6-1. ଻㒾ᢱ ............................................................................................................................................................ 121
6-2. ㅊട଻㒾ᢱ .................................................................................................................................................... 123
6-3. ㅪ㇌⵬ഥ㊄ .................................................................................................................................................... 124
6-4. ක≮ၮ㊄䈱ᓎഀ............................................................................................................................................. 125

࠼ࠗ࠷ߦ߅ߌࠆක≮଻㒾೙ᐲߩᡷᱜ‫ޣ‬2012 ᐕ‫ޤ‬

129


1.

࠼ࠗ࠷ක≮଻㓚೙ᐲߩᴪ㕟㧔᭎ⷐ㧕130


2. 1970 ᐕઍ㨪2000 ᐕઍߩਥߥᡷᱜ133

2-1. 1970 ᐕઍߩᡷᱜ ........................................................................................................................................... 133
2-2. 1980 ᐕઍߩᡷᱜ ........................................................................................................................................... 134
2-3. 1990 ᐕઍߩᡷᱜ ........................................................................................................................................... 137
2-4. 2000 ᐕઍߩᡷᱜ ........................................................................................................................................... 139―v―

3. CDU/CSU ߣ FDP ߩㅪ┙᡽ᮭߦ߅ߌࠆක≮଻㒾ᡷ㕟

143

3-1.㩷 CDU/CSU 䈫 FDP 䈱ㅪ┙දቯ䈮䈍䈔䉎ක≮᡽╷........................................................................................ 143
3-2.㩷 ଻቞ㅪ┙᡽ᮭߩᡷ㕟.................................................................................................................................... 145ක≮଻㓚ෳ⠨ᢥ₂         149ක≮଻㓚㑐ㅪන⺆㓸        191ක≮㑐ㅪᖱႎࠨࠗ࠻        ࠼ࠗ࠷ߩㅢ⽻ߪ‫ޔ‬2002 ᐕ 1 ᦬ 1 ᣣࠃࠅࡑ࡞ࠢ߆ࠄ࡙࡯ࡠ߳৻ᢧߦಾࠅᦧ߃ߣߥߞߚ‫ޕ‬㧔1 ࡙࡯ࡠ㧩1.95583 ࡑ࡞ࠢ㧕― vi ―205