Germany has a universal [1] multi-payer health care system ( Gesetzliche Krankenversicherung ) officially called „sickness funds“ ( private Krankenkassen ) and private health insurance ( private Krankenversicherung ), colloquially also called „(private ) sickness funds „. [2] [3] [4] [5] [6]
The turnover of US $ 368.78 billion in 2010, equivalent to 11.6 percent of gross domestic product (GDP) and about US $ 4,505 (€ 3,510) per capita. [7] According to the World Health Organization , Germany’s health care system was 77% government-funded and 23% privately funded as of 2004. [8] In 2004 Germany ranked thirtieth in the world in life expectancy (78 years for men). It was a very low mortality rate (4.7 per 1,000 live births3.3 per 1,000 persons, and 3.3 per 1,000 persons. In 2001 total expenditure on health amounted to 10.8 percent of gross domestic product. [9]
According to the Euro health consumer index , which placed it in 7th position in its 2015 survey, Germany has had the most restriction-free and consumer-oriented healthcare system in Europe. Patients are allowed to seek care whenever they want it. [10]
History
Germany Has the world’s national social oldest health insurance system, [1] with origins dating back to Otto von Bismarck ’s social legislation , qui included the Health Insurance Bill of 1883 , Accident Insurance Bill of 1884 , and Old Age and Disability Insurance Bill of 1889 . Bismarck stressed the importance of three key principles; solidarity, the government is responsible for ensuring that the policies are implemented with smallest political and administrative influence, and corporatism, the government representative bodies in health care professions and procedures they deem feasible. [11]Mandatory health insurance recently applied only to low-income workers and some employees. [12]The system is decentralized with private practice. Approximately 92% of the population are covered by a ‚Statutory Health Insurance‘ plan, which provides a standardized level of coverage through any one of 1,100 public or private sickness funds. Standard insurance is funded by a combination of employee contributions, contributions and government subsidies. Higher income workers opt for a flat rate and opt out of the standard plan, in favor of private insurance. The latter’s premiums are not linked to income level but instead to health status. [13] Historically, the level of provider reimbursement for specific services is determined by negotiations between regional physicians and sickness funds.
1970-Present
Since 1976 the government has convened an annual commission, composed of representatives of business, labor, physicians, hospitals, insurance and pharmaceutical industries. [14]The commission takes into account government policies and makes recommendations to regional associations with respect to overall expenditure targets. In 1986, expenditure caps were implemented and were tied to the local population and to the overall wage increases. The provision of services is not included in the rate of reimbursement. Provided by US health maintenance organizations, and has not been included in the scope of this agreement. [15]
Copayments were introduced in the 1980s in an attempt to prevent overutilization and control costs. The average length of stay in Germany has decreased in the US (5 to 6 days). [16] [17] The difference is partly driven by the fact that hospital reimbursement is chiefly a function of the patient’s diagnosis. Drug costs have increased substantially, rising nearly 60% from 1991 through 2005. Compared with other countries in the US (nearly 16% of GDP). [18]
Regulation
The healthcare system is regulated by the Federal Joint Committee ( Gemeinsamer Bundesausschuss ), a public health organization authorized to make binding regulations growing out of health reform Bills Passed by lawmakers, along with routine decisions Regarding healthcare in Germany. [19]
Health insurance
Health insurance is compulsory for the whole population in Germany. Salaried workers and employees below 50,000 Euros per year are automatically enrolled in a public non-profit „sickness funds“ at common rates for all members, and is paid for . Provider payment is negotiated in complex corporatist social bargaining among specified self-educated bodies (eg physicians‘ associations) at the level of federal states(Lander). The sickness funds are mandated to provide a single and broad benefit package and can not be denied membership or otherwise. Social welfare benefits are also enrolled in statutory health insurance, and municipalities pay contributions on behalf of them.
Besides the „Statutory Health Insurance“ ( Gesetzliche Krankenversicherung ) covering the vast majority of residents, the better off with a yearly income of € 50,000 ( US $56,497), and 11% of the population. Most civil servants benefit from a tax-funded government employee benefit scheme covering a percentage of the costs, and cover the rest of the costs with a private insurance contract. Recently, additional insurers provide various types of supplementary coverage for the benefit package (eg for glasses, coverage and additional dental care or more sophisticated dentures). Health insurance in Germany is split in several parts. The largest part of the population is covered by a comprehensive health insurance plan provided by statutory public health insurance and regulated by the Sozialgesetzbuch V (SGB V), which defines the general criteria of coverage, which are translated into the Federal Joint Committee. The remaining 11% opt for private health insurance, including government employees. [20]
All wage workers pay a health-insurance contribution based on their salary if they are enrolled in the private subsystem private insurers charge risk-related contributions. This may result in substantial savings for good health. With age, private contributions tend to rise and a number of insurees formally canceled their private insurance plan in order to return to statutory health insurance; this option is now only available for beneficiaries under 55 years. [13] [21]
Reimbursement for outpatient care is based on a fee-for-service basis. Moreover, regional panel physician associations regulate the number of physicians allowed to accept Statutory Health Insurance in a given area. Co-payments, which exist for medicines and other items are relatively low compared to other countries.
Insurance systems
Germany has a universal multi-pay system with two main types of health insurance. Germans are entitled to a compulsory health benefits, which are co-financed by employer and employee: health insurance, accident insurance, and long-term care insurance.
Accident Insurance for Working Accidents ( Arbeitsunfallversicherung ) is covered by the employer and is a general practice.
Long-term care ( Pflegeversicherung ) is covered half and half by the employer and covers the daily routine (provision of food, cleaning of apartment, personal hygiene, etc.). It is about 2% of a yearly wage-earner or pension, with employers matching the contribution of the employee.
There are two separate types of health insurance: public health insurance ( Gesetzliche Krankenversicherung ) and private insurance ( Private Krankenversicherung ). Both systems struggle with the increasing cost of medical treatment and the changing demography. About 87.5% of the persons with health insurance members of the public system, while 12.5% are covered by private insurance (as of 2006). [22]
Public insurance
Regular employees must have public health insurance. Only public officers, self-employed people and employees with a large income, above c. € 50,000.00 per year, the join the private system.
In the public system the premium
- is set by the Federal Ministry of Health based was fixed set of covered services as described in the German Social Law (Sozialgesetzbuch – SGB), qui Those limits services to „economically viable, Sufficient, Necessary services and Meaningful“
- It is not a percentage of income, but a percentage (currently 15.5%, 7.3% of which is covered by the employer) of employee income under € 52,200.01 per year.
- include family members of any family members, or „registered member“ ( Familienversicherung – ie, husband / wife and children are free)
- is a „pay as you go“ system – there is no saving for an individual.
Private insurance
In the private system the premium
- The definition of an insurance company and the coverage of services
- Depends on the amount of services chosen and the person’s risk and age of entry into the private system
- is used to build up savings for higher education (required by law)
For persons who have opted out of the public health insurance system to obtain private health insurance, it is possible to age and their income drops below the level required for private selection. Since private health insurance is usually more expensive than public health insurance [ citation needed ] , the higher premiums must then be paid out of a lower income. During the last twenty years [ when? ] private health insurance has become more efficient and more efficient compared with the public insurance. [ quote needed ]
In Germany, all privately financed products and services are assigned as part of the second health market. [23] Unlike the ‚first health market‘ they are usually not paid by a public or private health insurance . With Billion Euro in this market segment in 2011, where already 82% of patients in their practices are not covered by the patient’s insurances; the benefits of these services are controversial discussed. [24] Private investments in fitness , for wellness, assisted living, and health tourism are not included in this amount. The ’second health market‘ in Germany is compared to the United States still relatively small, but is still growing.
Economics
Health economics in Germany can be considered as a collective for all activities that have anything to do with health in this country. [25] This interpretation by Andreas Goldschmidt in 2002 seems, however, very generous due to several overlaps with other economic sectors . [26] A simple outline of the health sector in three areas provides an “ model of health care economics “ by Elke Dahlbeck and Josef Hilbert [27] from „Institute Arbeit und Technik (IAT)“ at the University of Applied Sciences Gelsenkirchen : [28] Core area is the ambulatory and inpatientacute care and geriatric care , and health administration . It is located around and beg wholesale sector with pharmaceutical industry , medical technology , healthcare, and wholesale trade of medical products. Health-related margins are the fitness and spa facilities, assisted living , and health tourism .
According to this article, the idea of an almost complete UK market was not very productive, but also largely marketed in the United States would not be optimal. Both systems would be in need of sustainable and comprehensive patient care. Only a hybrid of social well-balanced and competitive market conditions. [29] Yet forces of the healthcare market in Germany are often regulated by a variety of amendments and health care reforms, especially by the Social Security Code (Sozialgesetzbuch-SGB) in the past 30 years.
Health care in Germany, including its industry and services, is one of the largest sectors of the German economy . Direct inpatient and outpatient care equivalent to a quarter of the entire market – depending on the perspective. [30] A total of 4.4 million people working in this field, which was measured in 2007 and 2008. [31] The total expenditure in health economics was about 287.3 billion Euro in Germany in 2010, equivalent to 11.6 percent of gross This product is about 3.510 Euro per capita. [32]
Drugs costs
The pharmaceutical industry plays a major role in Germany. Expenditure on pharmaceutical drugs is almost half as high as those for the entire hospital sector. Pharmaceutical drug expenditure Grew by an annual average of 4.1% entre 2004 and 2010. Such Developments since the 1980s Caused Numerous health care Reforms . An actual example of 2010 and 2011: First time since 2004 the drug expenditure fell from 30.2 billion Euro in 2010 to 29.1 billion Euro in 2011, ie minus 1.1 billion Euro or minus 3.6%. That was caused by restructuring the Social Security Code: manufacturer discount 16% instead of 6%, increasing moratorium prices, increasing discount by wholesale trade and pharmacies. [33]
Statistics
The reduction in infant mortality between 1960 and 2008 for Germany (green) in comparison with Australia, France, the Netherlands, the United Kingdom, and the United States.
In a sample of 13 developed countries in the United States of America and the United States, the results of this study were presented in the following table. significant long-term morbidity and inculcation high levels of expenditure and significant development in the last 10 years. The study noted considerable difficulties in cross-border comparison of medication use. [34] It has the highest number of dentists in Europe – 64,287 in 2015. [35]
Major diagnosis
In 2002 the top diagnosis for male patients released from the hospital Was heart disease , Followed by alcohol-related disorders and hernias . For women, the top diagnoses related to pregnancies, breast cancer, and heart disease . [ quote needed ]
Hospitals
The average length of hospital in Germany has decreased in recent [ when? ] years in the United States (5 to 6 days). [36] [37] Part of the difference is that the chief consideration for hospital reimbursement is the number of hospital days. [ citation needed ] Drug costs have increased substantially, rising nearly 60% from 1991 through 2005. Compared with other European countries spent in the US (nearly 16% of GDP). [38]
The Charity university hospital in Berlin
An incomplete list of university hospitals in Germany is:
- Universitätsklinikum Freiburg , Freiburg ,
- Universitätsklinikum Heidelberg , Heidelberg ,
- Rechts der Isar Hospital , Munich ,
- Charity – Universitätsmedizin Berlin , Berlin ,
- University Medical Center Hamburg-Eppendorf , Hamburg ,
- Universitätsklinikum Gießen und Marburg ,
- Universitätsklinikum Aachen , Aachen ,
- Universitätsklinikum Bonn , Bonn .
In 2017 the BBC reported that compared with the United Kingdom the Caesarean spleen, the use of MRI for diagnosis and the length of hospital stay in Germany. [39]
Waiting Times
According to several sources from the past decade, waiting times in Germany remain low for appointments and surgery, although a minority of elective surgery patients face longer waits. In 1992, a study by Fleming et al. (cited in Siciliani & Hurst, 2003, p.8), [40] 19.4% of German respondents said they would wait for more than 12 weeks for their surgery.
In the Commonwealth Fund 2010 Health Policy Survey in 11 Countries, Germany reported some of the lowest waiting times. Germans had the highest percentage of patients reporting their last specialist appointment (83%, v. 80% for the US), and the second-lowest reporting it took 2 months or more (7%, vs. 5% for Switzerland and 9% for the US). 70% of Germans reported that they waited less than 1 month for elective surgery, the highest percentage, and the lowest percentage (0%) reporting it took 4 months or more (The Commonwealth Fund, 2010, pp. 19-20). [41]
Both Social Health Insurance (SHI) and privately insured patients experienced low rates, but privately insured patients‘ waits were even lower. According to the Kassenärztliche Bundesvereinigung (KBV), the body is contracted by 56% of Social Health Insurance patients waited 1 week or less, while only 13% waited longer than 3 weeks for a doctor’s appointment. 67% of privately insured patients waited 1 week or less, while 7% waited longer than 3 weeks (Kassenärztliche Bundesvereinigung, 2016). [42]
Intersection of private insurance, interviewers posed as patients and requested appointments. They told hospitals they could not get a normal referral, which is usually required from an outpatient doctor. Care requested was not urgent, but was urgently needed. (This may limit generalization to other waits). Mean waiting time was 8.9667 days. Those posing as SHI patients waited longer, and longer on average. Not all hospitals asked their insurance status. However, among those that did, mean waits for SHI patients was 10.5533 days, while privately insured patients‘ mean waiting time was 8.9667 days. Hospitals asking for insurance (Kuchinke,[43]
Waits also varied somewhat by region. Wides were longer in eastern Germany according to the KBV (KBV, 2010), as cited in Health at a Glance 2011: OECD Indicators . [44]
Germany has a large hospital area. High hospital on the other hand (especially for ophthalmology and othopaedic surgery) with doctors paid fee-for-service for the cost of treatment. Siciliani & Hurst, 2003, 33-34, 70). Germany introduced Diagnosis-Related Group activity-based payment for hospitals (Busse & Blümel, 2014, pp. 142-148). [45]