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  1. Reinhard Hohlfeld*,
  2. Thomas Brandt
  1. *Consultant Neurologist and Professor of Neurology, Institute for Clinical Neuroimmunology, and
  2. Consultant Neurologist and Professor of Neurology, Department of Neurology, University Hospital Munich, Marchioninistr. 15, 81377 Munich, Germany; E-mail: thomas.brandt{at}, or reinhard.hohlfeld{at}


Recently a well-known German newspaper declared the word ‘reforms’ as ‘the most tedious word of the year.’ This no doubt was due to the fact that so many reforms and changes have been discussed – and in part already implemented – in Germany in the past few years that many Germans cannot stand hearing the word anymore. The enthusiasm for reform has also taken hold of the health system. To understand the implications it is important to realise that the three pillars of the German social security system – accident, illness, and retirement insurance – have prevailed for more than a century since being introduced by Otto von Bismarck, Chancellor of the German Reich. The German social system was considered world-wide to be particularly just and efficient. However, the economic situation has so altered that changes in this social security system are no doubt necessary. On the one hand, the economic burdens resulting from

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