Since 2000, two reform packages have been debated in parliament. The first was mainly concerned with reform
of risk equalization between insurers, financing of long-term care, monitoring of insurers, SHI enrollee cards,
selective contracting, premium reduction, and cost-sharing. The second involved reform of hospital funding
and managed care. New financial arrangements for long-term care went into effect in 2011, and hospital payment
was fully converted to the DRG system in 2012. The refined risk equalization formula has been in use
since 2012 and will be changed to a fully prospective system in 2014. However, the parliament’s proposed law to
promote managed care was rejected in a popular referendum in June 2012