Values and structure in the German health care systems.

Abstract

values and health care, no work addresses the divided Germany that was forced into existence following the conclusion of World War II. The omission is surprising since the resultant individualistic West and the Communist East provide the researcher with a "natural experiment" in history, one in which a third of the world's oldest and perhaps most sophisticated health care system itself became an experiment in the application of Marxist/socialist ideology. Examining this experiment has distinct advantages over other comparisons of health care under Communist versus non-Communist governments. If one compares health care services .before and after a Communist takeover, one is unable to examine how the former society and its health care system would have evolved over time had a political upheaval not taken place. Alternately, if one compares a Communist and a non-Communist system in two countries during the same period, the problem of periodicity is solved but the problem of comparability is increased. Inevitably, there are differences of language, culture, history, medical institutions, forms of insurance, and other relevant variables. Happily, the German experience comes as close as is humanly possible to what Campbell (1969) calls a quasi experiment, in which