Personal responsibility for health--developments under the German Healthcare Reform 2007.

Appeals to personal responsibility for health are controversial in many countries, especially in those that have publicly funded healthcare systems. In Germany, personal responsibility has traditionally been a focal point in the statutory health-insurance scheme. The most recent healthcare reform under the motto 'prevention before treatment, rehabilitation, and long-term care' came into force on 1 April 2007 through the Gesetz zur Stärkung des Wettbewerbs in der gesetzlichen Krankenversicherung (GKV-WSG--"Law to strengthen competition among providers of statutory health-insurance scheme"). In significant parts, the law has given further emphasis to the role of personal responsibility. Implications of three important changes are discussed: (1) insured persons may no longer claim free treatment for complications arising from certain 'lifestyle choices'; (2) chronically ill and cancer patients face more stringent compliance requirements or face higher co-payments; and (3) insured persons may cash 'no-claim bonuses' if over at least one year they do not require hospitalisation or prescription medicines. Previous emphasis on personal responsibility has had relatively broad support in Germany. The long-term acceptability of the new measures will depend on several factors, including the structural and financial impact on different providers of statutory health insurance, and the capacities and opportunities of different groups in society to make use of the new provisions.