The impact of recent legislative change in Germany.

Cost-containment policies introduced in Germany under the 'Health Structure Act' at the beginning of 1993 marked a dramatic turnaround in German healthcare policy. The traditional arms-length approach of government policy makers, under which responsibility for implementation of the measures specified in national legislation was devolved upon the representatives of healthcare providers and statutory health insurance funds, was replaced by government mandates at the national level. These mandates-including price controls, a national pharmaceuticals budget and copayment changes-had a dramatic impact on the German healthcare system and on the German pharmaceutical market in particular. Eventually, these national controls are to be phased out as the associations of healthcare providers and health insurance funds negotiate the terms for implementation of further measures specified in the 'Health Structure Act': regional budgets, prescription guidelines, stricter controls of prescribing behaviour and a positive list. Despite this gradual return to the federalistic principles of the German healthcare system, the German pharmaceutical market will never be the same.