How Germany provides health care
Today’s health-care system in Germany is a blend of public and private programs. “Regulated competition” is one description of the system. Participation is mandatory.
Statutory Health Insurance plans (SHI), so-called “sickness funds,” cover 85 percent of the population. There are 124 separate, nongovernmental, nonprofit SHI plans. These are financed by mandatory contributions based on a fixed-percentage of gross income up to a ceiling. Contributions do not vary by age or gender. Coverage includes preventive services, outpatient and inpatient care, physician fees, mental health, dental and optometric services, most prescription drugs, rehabilitation and hospice services and sick-leave compensation.
Most services require modest co-payments. For example, a patient might be charged for meals during a hospitalization. Children under age 18 years and nonworking spouses are covered at no additional charge. Subscribers to SHI plans may purchase supplementary private plans to cover amenities such as private hospital rooms and expanded dental services.
Private health insurance plans (PHI) are available to those earning more than 54,000 Euros ($61,340) annually. Seventy-five percent of people in this income range choose SHI coverage.
Long-term care insurance is mandatory and provided through the SHI funds. Funding is shared by contributions from employers and employees.
Undocumented immigrants and refugees are covered in the event of illness, pregnancy or childbirth.
Seventy-three percent of health care is funded by the government; 27 percent represents PHI or out-ofpocket costs. For an adult, out-of-pocket expenses are capped at 2 percent of household income.
Outpatient physicians work in private practices or clinics. Everyone enrolls as a patient of a practitioner who serves primary-care needs and arranges specialist care when indicated. Inpatient physicians are employed by the hospitals in which they work. Half of hospitals are publicly owned. A third are privately owned, nonprofit facilities. The remainder are private, for-profit institutions.
The central government formulates policy, sets standards for practice and supervises overall performance of the healthcare system. Self-governing bodies representing the SHI and providers negotiate contracts and compensation for providers and manage budgets within each region of the country.
Electronic health records are employed by more than 90 percent of providers to facilitate appropriate sharing of records among providers.
Rehabilitative services in Germany are especially strong, presenting a patient with an array of services ranging from specialized clinics to spas.
I spoke with several people with firsthand knowledge of Germany’s health-care system. They shared a high regard for the system. They characterized it as predictable — no surprise charges or uncovered expenses. Bankruptcy or loss of one’s home due to medical costs does not occur. There is no burden of uncertainly regarding pre-existing conditions or limits to coverage. Waiting times for elective surgery or specialty consultations are generally a matter of days. Sick pay is maintained during periods of illness and recovery.
Among international health-care systems, I rank that of Germany at the top. The likelihood of adopting a similar program in the U.S. is remote, however, because of lack of consensus among our legislators and competing interests of long-established, powerful groups of insurers, providers and manufacturers of pharmaceuticals and medical devices. Advocates for reform of our disjointed system would do well to study Germany’s success story in health care.
The Commonwealth Fund offers succinct, profiles of international healthcare systems at www.commonwealthfund.org.
Contact Clif Cleaveland at ccleaveland@timesfreepress.com.