Health Care in Germany

Health Care in Germany

By

Nabil Fakhoury

Florida Atlantic University

Into to Health Care Systems (HSA 6103)

Dr. Shehadeh

Fall 2014

Table of contents

Abstract2

Introduction2

Access and Coverage2

Expenditures and Finance3

Advantages4

Drawbacks5

Hospitals and physicians5

Conclusion7

Introduction

The German health care system can be traced back to the 1883, when Von Bismark passed a health insurance bill into a law. The German health care model is still known as the “Bismark Model” nowadays (Khazan, 2014). Despite all the controversy surrounding many of the changes the German system has undergone, Germany is still able to spend a fraction of what the United States spends on health care while providing good quality care that is accessible to everyone (Green & Irving, 2001). Germany spends $4,495 per capita while the U.S. Spends $8,508 per capita (Gopffarth, 2012). According to Dr. Dirk Gopffarth, Germany favors balancing its health care management over balancing the market competition (Gopffarth, 2012). The German health care system has many benefits and drawbacks which are discussed later. Health care financing relies mostly on sick funds and government contributions. Germany is the only country in European Union with a supplemental private health insurance (Riesberg & Worz, 2008). The majority of insurance in Germany is provided though the public statutory health insurance system. The system consists of approximately 242 different sickness funds that determine eligibility on a per family basis (Green & Irving, 2001). The hospital system in Germany is very different from the U.S., with public hospitals making up more than half of the total number of hospitals.

Access and Coverage

As of 2009, all Germans citizens are required to have health insurance by law. The Public Statutory health Insurance Scheme (SHI) covers those who earn less than 49,500 euros per year. Those who earn more than 49,500 Euros have the option to buy into a private health insurance plan but can no longer return to the SHI plan (Green & Irving, 2001). Citizens with statutory health insurance or private health insurance have access to the same providers (Riesberg & Worz, 2008). Approximately 95% of the 82.5 million Germans are covered by the statutory health insurance and the remaining 5% are covered by private health insurance (Riesberg & Worz, 2008). About 5% of all government insurance recipients have supplementary private insurance to cover the 50-20% difference in costs not covered by statutory health insurance (SHI) (Riesberg & Worz, 2008). The 2007 reform was introduced to eliminate the number of uninsured, which account to 0.2% of the total population (Riesberg & Worz, 2008). Germans are facing the similar problems Americans on Medicaid face when it comes to access to healthcare. Germans with statutory insurance coverage are reporting longer waiting times than those with private insurance (Gopffarth, 2012).

Statutory Health Insurance covers a broad range of services that have been approved by the Federal Joint committee. SHI covers preventative services including pregnancy and early detection of cancer and major illnesses, hospital inpatient and outpatient care, physician services, rehabilitation, mental health care, dental care, nursing care for those who cannot be hospitalized, prescription drugs, and rehabilitation (Green & Irving, 2001). Long-term care requires a separate insurance scheme in which employers and employees contribute a combined 1.95 percent of gross salary; enrollees without children contribute an additional 0.25% (Green & Irving, 2001).

Expenditures and Finance

Germany’s total healthcare expenditures accounts for 10.9% of gross domestic product compared to 17.9% in the U.S. (Green & Irving, 2001). SHI contributes to 56% of the funding in 2004, the rest of contributions come from complementary sources such as the statutory long-term care insurance, accident insurance, local governments and municipalities, out of pocket payments and non-governmental institutions (Green & Irving, 2001). In all, public sources contribute to 73% of total expenditures, while private sources contribute the remaining 27%. Sickness funds are primarily funded by payroll taxes, which account to 15.5% of gross income. Enrollees pay 8.2% and employers cover the remaining 7.3%. Those who do not work can access sickness funds by paying a proportion of their unemployment benefits (Green & Irving, 2001). Unlike American citizens, Germans contribute a fixed rate to their sickness fund annually. In 2009, the government established the Central Health Funds (CHF), which collects all contributions and then redistributes the funds to the sickness funds according to a risk equalization formula. Sickness funds with high-risk patients are allocated more money (Green & Irving, 2001).