Germany Health Care System

By: Johanna Strange, Alyssa Vara, Alexa Guerrero, Oscar Tu, Meghan Cantu

Nature of Health Care

Germany has one of the strongest economies in Europe today.

"The national gross income (GNI) per capita is $35,940, about one quarter lower
than in the United States(Weitz pg.213)".

As for health expenditures Germany currently spends about $5,006 per capita
on health care.

Unlike the United States economic model, Germany is based on a system of

social insurance.

"Social insurance refers to insurance provided by large social groups (such as cities,
occupations, or industries) to their residents or members.(Weitz pg.213)"

This system was adopted in 1883 in hopes to lead the country into a more
radical redistribution of power and wealthin German society.

Nature of Health Care

About 90% of Germany's health insurance is provided by nonprofit social insurance

groups known as the sickness funds.

The social insurance provided by the German government is a universal coverage.

Although about 12% of the German population choose to purchase private insurance,
social insurance continues to be the center of the health care system, which leaves the
role of the private enterprises in the German health care system is measured to be
moderate unlike the U.S.

Although the cost of health care in Germany is rising due the overage of doctors in the
country.

Germany has a high standard of living and commitment to providing the best
social services to its population which is leading to an increase in life expectancy
compared to the United States, although East Germany remains poorer than West
Germany the differences between the two regions are rapidly disappearing.

Access and Availability

1.Statutory health insurance

89% of the German Population is covered under the statutory funding

2.Private Health insurance

11% is covered by a private insurer.

Access and Availability

When you begin working in Germany, you will automatically be enrolled into a health care fund if you
fall below a threshold salary. The determining salary is 50,000 (US$66,337). Those who make less
than that salary, theyre automatically enrolled and they usually stay in the statutory funding.

Those who make a higher salary usually choose to opt out of the funding. These employees include
public officers, self-employed people and employees with a large income. This automatic enrollment
is one way in which access to services is extremely high in Germany as compared to other countries.

Because Germany has such a high number of specialists readily available, patients do not have to wait
for an appointment to be seen. Compared to other countries, Germany perhaps has the most
practicing specialists than anywhere else. In the UK, there are about 1.5 specialists to every one
thousand people. In Germany its 2.3 to every thousand.

You can go to any doctor at any time or day after you are enrolled in a health care system. The only
downfall is that you get what you pay for.

The amount of income a person makes in Germany, will be the determining factor in receiving health
care. If a citizen decides to unroll, their only other option is to seek out their own health care
provider. These private health care providers are readily available as well but most citizens choose to
partake in the Germany sickness fund.

Funding for Health

How is the health system financed:

Publicly-financed scheme (SHI)-

operated by over 200 competing health insurance funds

autonomous, not-for-profit, non-governmental bodies regulated by law

Overview:

Germany is based on a system of social insurance. Where insurance is paid by large

social groups ( cities, occupations, and or industries)

Funding for Health

(Non-profit social insurance group)
Sickness funds(employee/ payroll taxes)

funded largely by large social groups

90% of the population

(private insurance (PHI))

based on occupation
Germans earning less than 70,000 must
join the sickness fund
anyone below this income has to pay a
premium

cost is 15% of income (half paid for by

individual for entire family, other half paid
for by the employer)

coast based on income

you pay based on your age and health

you pay a risk related premium

you pay a premium for dependents

premiums are regulated by the government to ensure the insured do

not face massively increased prices

10% of population

Funding for Health

Paying Doctors and Hospitals

Paying Doctors and Hospitals

1.(doctors: Fee-for-service basis payment

system)

Paying Doctors and Hospitals

salaried

Capitation- doctors are paid a set amount from sick

fund per person, regardless of how many time they see
the patient or service provided by the doctor

2.(hospitals: sickness funds and capital budgets)

receive lump sums from government and social

insurances

Sickness funds- (receive majority of operating budgets from large social groups

all Germany receive a health care package

minimum co-payments

insurance covers all cost of dental, maternity care,

hospitalization, ambulance care, prescriptions,
preventive measures like vaccinations, as well as
income loss due to illness

Two factors that prevent decrease in health care cost:

hospitals have opposed policies

designed to change care to less
expensive outpatient settings

a majority of health insurance

companies in the German system have
kept administrative cost high

Comprehensive health care package-

3.controlling hospital cost

government restrains the purchase of

unnecessary and expensive technologies
because it sets the hospital budgets

Capital budget - receive money from the government for new machines and equipment

sickness fund encourages healthcare

providers and consumers through
education to adopt cost-effective drugs

2.Controlling drug cost

Role of Health Care Providers

Providing care: Separated into 3; public health services, ambulatory care, hospital care

Physicians and treatment

NO GATEKEEPER SYSTEM but primary care physicians can refer patient to specialist;
reimbursed care (reimbursement for the patient) is only available if the treatment is
physician-referred, although patients are free to choose other healthcare providers

Treatments are largely planned out through DMP, a treatment plan which is created in a
contract between physician and the respective sickness fund (sometimes hospitals
participate in DMP)

Disease Management Programmes: treatment plans aimed at the ambulatory care

level

DMP covers the types of treatment used and the drugs prescribed

Deviations from set DMP must be explained to patient

Role of Health Care Providers

Public

health
Primary prevention and health promotion: focus on epidemiology, disease prevention,
and protection of the most vulnerable populations (children, elderly, mentally ill,
especially debilitating illnesses)
Physicals examinations of children and other at-risk groups
Occupational health promotion
Overseeing environmental hygiene
Supervision of hygiene in hospitals and private practices
Health reporting and surveillance of communicable diseases
Diagnosis and/or therapeutic services for STDs, TB, cancer, and certain other illnesses
Provide community based mental care services
Private practice physicians are obligated to provide screenings and early detection
services, as well as vaccinations, since these are covered in SHI benefits packages

Role of Health Care Providers

Ambulatory care - care provided on an outpatient basis (outside of a hospital, in private

facilities/practices) who are generally under contract with an insurer

Mainly provided by private, for-profit providers (physicians and other specialists)

Growing popularity of interdisciplinary care through medical treatment centers, sponsored

by SHI; becoming more popular than private practises

Centers are made up of various professionals who are led by a physician and are
regulated by SHI physicians

Physicians who practice ambulatory care are paid through sickness funds, payment from private
health insurers, and sometimes, from the patients

2004: FAMILY PHYSICIAN CARE MODEL

Encouraged citizens to use primary care physicians as gatekeepers, offering discounts on

co-payments if patients followed primary physicians recommendations

Primary care: Overworked

Very long hours (50+ on average)

About 70% of week is spent with patients, numbering to about 250, leading to less than 10
minutes per patient

Role for Health Care Providers

Hospitals: concentrates on inpatient care, staffed by salaried physicians

Public hospitals: Run by local authorities, towns, and states

Non-profit hospitals: Run by churches/non-profit orgs like the German Red Cross

Private hospitals: Free commercial enterprises

May provide ambulatory care services for:

Highly specialized services, patients with rare diseases/unusual disease progression

Specialities which are specified by the law as underserved

Diagnosis-Related Groups: Inpatient care is paid by a method which tags certain kinds of
disorders with general cost

Emergency Care

Mostly covered in ambulatory care during practise hours and after-hours practice

After-hours practice is taken in order to create a better bond between healthcare

providers and community

Effectiveness of Health Care

The life expectancy at birth for men and women is slightly higher than the
OECD ( Organisation for Economic Cooperation and Development) computed
average which is Males ( 77.8) Women (83.0) vs Germanys averages of Males
(78.6) Women (83.2).

Life expectancy at birth for both sexes increased by 3 year(s) over the period
of 2000-2012; the WHO region average increased by 4 year(s) in the same
period.

Germany has a low <5 year mortality rate of 4/1000 live births. And a low
Maternal mortality ratio of 7/100,000 live births. Both ratios are lower than
the WHO average.

They also have a lower rate of death due to HIV/AIDS and Tuberculosis

Some of the Health risks that Germany faces such as Alcohol and Smoking also differ from the OECD
average. With alcohol consumption at higher rates than the OECD but both averages are steadily
decreasing. However smoking rates which have been lower than the OECD average in the past have
now become higher in recent years.

Health Expenditure - Higher than the OECD but still not as high as the US.
spending only half of what the U.S. does

There is an increasing
proportion of the
population in the 50-54
age range that is causing
an increase in the need
for senior health care.

Effectiveness of Health Care

Over all this data shows that Germanys population is relatively healthy
compared to standardized averages set by the WHO and OECD. For the health
expenditure paid per person the quality and access to care that the german
healthcare system provides is quite reasonable. Although health expenditure
is always rising the demand for senior care will soon play a major part of the
Germany healthcare system priorities.

Sources

http://www.compareyourcountry.org/health?cr=oecd&cr1=oecd&lg=en&page=3
http://www.who.int/countries/deu/en/

http://www.euro.who.int/__data/assets/pdf_file/0008/255932/HiT-Germany.pdf?ua=1

http://www.bundesaerztekammer.de/fileadmin/user_upload/downloads/pdf-Ordner/MBO/MB
O_EN_Novellierung_2015.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447688/

http://www.germanyhis.com /
http://www.commonwealthfund.org/~/media/files/resources/2008/health-care-system-profi
les/germany_country_profile_2008_2-pdf.pdf

https://en.wikipedia.org/wiki/Healthcare_in_Germany

http://www.mygermancity.com/health-care-in-germany

The Sociology of Health, Illness, and Health Care by Rose Weitz

http://data.worldbank.org/country/germany