The German state has been regarded as an exemplary state for the health care it provides its citizens. The German Health Care System dates back to 1883 when chancellor Otto von Bismarck proposed this universal health model. Germany and many other European countries adopted this system.
The German health care system is composed of Statutory Health insurance and Private Health Insurance. The majority of Germany's almost 83 million citizens are enrolled in "sickness funds" or not for profit insurance companies, there are over 162 not for profit companies that provide easy access for the population. The government pays for all children and unemployed or welfare recipients. Employed people making below the relatively high income threshold, about $60,000 per year, share contributions to their sickness fund with their employer.
The wealthy?
Those earning more than $65,000 per year have the option of purchasing private insurance. As of 2013 in German, 76.8% of health care is government funded and 23.2% is privately funded according to the World Health Organization.
Is Health Care a Human Right in Germany? Yes.
According to the 2010 Human Rights Report, Germany declares as follows:
Section 6 Discrimination, Societal Abuses, and Trafficking in Persons
The constitution prohibits the denial of access to housing, health care, or education on the basis of race, ethnicity, gender, religious affiliation, age, sexual orientation, disability, language, or social status, and the government effectively enforced these provisions in practice.
Can the United States follow a similar low cost health care model? How can people in the U.S. voice their rights to achieve low cost health care?
By Edlira Qatipi
Thanks Edlira. Germany's healthcare system is based on a core believe that government should provide a range of social benefits including medical care, among other things constantly debated here in the US including pensions for seniors and maternity benefits.
ReplyDeleteThe system is Germany most resembles the Affordable Care Act in the US, such as in your description above: it is a mix of government and private insurance. Also, everyone must have health insurance. Low income residents must enroll in a government subsidized "sickness funds" and higher income residents need to buy coverage in the market, which is made up of a large variety of small and independent plans, like the US. No one can be turned away for coverage, there is a mandatory set of coverage benefits, and there are limits on out of pocket expenses.
One of the biggest differences between systems is level of government regulation. Central government passes legislation and policy, and state governments manage the hospitals, sickness funds, and physician associations. Physician associations can negotiate rates with the sickness funds, somewhat like here in the US between systems and insurance companies, but with more government intervention in Germany. Because of this structure, Germany is way ahead of the US in terms of cost containment. They face the same moral hazard issue as we do in the US- there's little incentive to control supply/demand on the patient side. Many of the cost containment strategies have in consequence reduced physician payments, so they also face the same issue of primary care shortages.
I think where the US leads the way is innovation in care coordination efforts. We have more room to try different pay for quality measures.
Back to costs... Germany sits in the upper third as you showed, so I wouldn't necessarily say it's low cost. Costs are rising there as well but there it's easier for providers to negotiate rates with the sickness funds and that becomes a uniform, transparent fee schedule, for patients, much less of the cost of care is passed on to them.
So while there are many similarities between the 2 systems I think the biggest difference is that in Germany, government is essential in managing healthcare delivery and spending. This is the big difference here, where there are pretty strong forces at play against any government involvement. Healthcare is seen as a commodity, traded on the free market... and in that type of system there will always be people that can't get in. We see that all too often, the people that don't have go without because people want to believe that the free market will somehow be fair.
So what we can do is know where our local and state representatives stand on social welfare issues, such as healthcare, and get out and vote. We should be less concerned about the Presidential race and more so about our Congressmen. You need the political will brought about by majority to push the needle on this.
Thank you Edlira for the information on Germany. Germany seems to be a country that is interested in providing healthcare to all the citizens of Germany and making sure everyone has healthcare. Providing health care is a human right to all. Yet many who are employed still lack coverage because of the cost and the lack of coverage with their current employers.
ReplyDeleteIt is no surprise the United Stated is the leader in spending on healthcare they have reached about $9,255 per person in 2014, which is about $2.9 trillion dollars vs. Germany in 2013 estimates $411.5 billion. Some of the major difference between Germany and the United States is Germany has an out-of-pocket limit that is covered by the "sickness fund". The sickness fund covers a bulk of the medical expense for German citizens. Germany makes sure their citizens pay a premium based on a percentage of their income, not based on class (low income or middle income) like the United States, making the amount of the premium equal between the classes.
Germany does have one major difference the United States. The citizens have to pay a higher income tax. All the citizens are in a higher tax bracket. This is how Germany pays for their healthcare cost. Making sure the wealthy here in the U.S. continue to be in a higher tax bracket will provide revenue for healthcare. This way the taxes could provide health insurance to everyone.
We still need to work on how to provide everyone in this country with affordable healthcare.