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Health Care in Germany
Transcript of Health Care in Germany
In 1949 when Germany separated into German Democratic Republic (GDR) and The Federal Republic of Germany (FRG) systems, the GDR tried to create their own health care system while the FDR stuck with the Bismarck Model.
The Bismark system was applied to alleviate the risk of work related incidents (1884), old age and disability (1889), unemployment (1927), and the need for long term nursing care (1994).
Although the Bismark Model is not the same as it was in 1881, it still has the same main concept it has just been modified as to who can access and receive health care.
Today, the Bismarck model has a blend of public and private health insurance.
Who is Covered in Germany
The Bismarck Model has been modified over the years as to who is eligible for health insurance.
In 1881, only certain segments were covered such as government workers and the elderly.
Today, health coverage is mandatory. As long as you have a passport and a residence permit you are entitled to healthcare insurance.
Insurance companies must accept all applicants.
90% of the population is covered by public health insurance.
10% of the population is covered by private health insurance.
Strengths and Weaknesses
In 1881 the Chancellor of Germany, Otto Von Bismarck, suggested a national health service type of system.
Germany is recognized as the first country to have introduced a public health insurance system.
During World War II, Hitler exported the system to the Netherlands, Belgium and France. It’s now generally called the Bismarck Model. The Bismarck model was so popular that after the war, even though it came from Hitler, these countries kept it.
After World War II health care and virtually all other sectors of German society began to bifurcate into systems that were complete opposites, which were The Federal Republic of Germany (FRG) and The German Democratic Republic (GDR). They were run separately from 1949 until they became unified in 1990. Public protests of GDR citizens for political and economic reforms led to the fall of the Berlin wall in November 1989 and ended the power of the German Democratic Republic. In 1990, the transitional GDR government and the FRG government signed the Treaty of German Reunification which integrated the GDR citizens into the FRG system.
The FRG system is still used in Germany until this day.
The population in Germany is 82, 726, 626 people which is 1.16% of the world's total population.
The life expectancy for males is 78 and for females it is 83
Infant mortality rate: 4 per 1,000 live births.
There is 3.4 doctors per 1,000 people.
.There are around 2260 hospitals with approximately 572 000 beds which is 6.97 beds per 1000 people
Germany spends 11% of its gross domestic product on healthcare
Public Health Care
Salary workers in Germany whose gross monthly income is less than 4,350 EUR which is $6,119 CA are entitled to public health care.
Almost 90% of the population is insured by the public system.
15.5% of worker's monthly salary is taken from their pay.
7.3% is contributed by the employer every month.
Contributions towards statutory health insurance with its current 453 sickness funds constitute the major system of financing health care in Germany.
Contributions are based on income not on individual risk.
If you are apart of the public health insurance, sickness fund membership is mandatory.
Until 1992, you had no choice as to which sickness fund you paid into. It was based on geographical and/or job characteristics. Ex/ If you were a carpenter, you belonged to the carpenters’ fund. But since 1992, people have been able to choose from any of the 400+ sickness funds.
Unemployed people remain members of the sickness funds they were in when employed
Stress-free to apply
Private Health Care
People earning more than 52,200 EUR which is $73,437 CA per year and the self-employed are eligible for private health insurance.
Application is more complicated and people may be subjected to medical tests.
People are charged fees based on individual risk.
More expensive than public healthcare.
What is Covered: Public Health Care
Prevention of disease
Screening of disease
Treatment of disease
Ambulatory medical care
Nursing care at home
Certain areas of rehabilitative care
Long term care facilities
If an employee goes on a sick leave the employer must pay the employee 100% of their income for the first six weeks. After that the sickness fund will pay the employee 80% of their income for up to 78 weeks per period of illness
Cost sharing has been integrated in the German health care system for a long time.
The pharmaceutical sector is the most traditional sector of the co-payment system.
The cost sharing mechanism could prevent users from utilization of health care. From the insurance designers’ side, the cost sharing could control the cost of health insurance scheme by correcting the problem of moral hazard
A higher level of cost sharing may make health insurance loose the function of financial protection
Health insurance continues with no change if you lose a job
If you declare bankruptcy, the social solidarity system pays for your medical care
Stress free to apply
Provides good quality care, short waiting times, and attentive service
European residents that are covered by their country's healthcare are entitled to a European health insurance card. This means that while traveling through Europe, the holder can receive the same treatment at the same cost as their country
Sickness funds were created so regular health insurance premiums do not increase to cover these extra costs
Some doctors only provide care to patients with private insurance
European health card needs to be renewed every year
Public healthcare does not cover all services (vision, full dental services)
There are not enough job opportunities in Germany to support people to pay for the expensive healthcare
Private health insurance application process is complex
Public healthcare is not balanced when it comes to revenue and expenses
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Competition between private and public funds now that people have a choice
Aging society results in raising the need for medical care. By increasing health care revenues from general taxes this could be an option to increase funding for the need for the older adult
We thought the German health care system
is run smoothly and efficiently. It is a good
model to build on and improve other healthcare
What is Covered: Private Health Care
Privately insured patients usually receive benefits equal to or better than those covered by statutory health insurance. However, this depends on the insurance package chosen.
Unlike SHI, privately insured people generally have to pay providers directly and are reimbursed by their insurer.
Public long-term care was introduced in 1994 due to the increasing concern from the public about the situation of the elderly
It is the first social insurance with practically population-wide membership
Long-term care model was also created to ease strain on the federal budget that resulted from the reunification of east and west Germany
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New York Times. 2013. Health Care Abroad: Germany. [online] Available at: http://prescriptions.blogs.nytimes.com/2009/09/29/health-care-abroad-germany/?_r=0 [Accessed: 1 Nov 2013].
YouTube. 2013. Lou Dobbs on Healthcare in Germany. [online] Available at: [Accessed: 4 Nov 2013].
Who.int. 2013. WHO | Germany. [online] Available at: http://www.who.int/countries/deu/en/ [Accessed: 11 Nov 2013].
German hospitals focus on inpatient care
The university hospitals have outpatient facilities for learning and research purposes
95% of the beds are publicly financed
Approximately 1400 institutions with 190,000 beds are dedicated to preventive and rehabilitative care
People who have public insurance get their bill sent automatically to the insurance company, but the patient must pay the 10 EUR for the first visit every quarter