Blog 5: Germany Health/Disease

Germany’s Healthcare System

     In the February 22, 2013 Health section of the New York Times, freelance writer Anne Underwood shares highlights of her 2009 interview with Uwe Reinhardt.  Reinhardt is a professor of health economics at Princeton University and is a leading researcher of the world’s health care systems. The highlights of the interview include Germany’s means of insuring all citizens, and why Germany’s healthcare system is such an efficient system.

     According to Reinhardt, Germany’s system is one that blends a private healthcare-delivery system with universal coverage and a sense of social harmony to create s system that brings satisfaction to most Germans. The German system mandates that all individuals have insurance, and it is up to each individual to select and enroll in a “sickness fund”.  The clear majority of Germans pay for their “sickness fund” coverage through a 50-50 agreement with their employer.  A “sickness fund” is much like a health insurance “plan” in the United States. There are over 200 sickness funds Germans may select from.  Employees select the fund, notify their employer of their choice, and pay half of the premium, and their employer pays the other half. Reinhardt notes that in Germany, employees would “balk” at the idea of their employer informing them what health plan they will be participating in.

      All employees in Germany must also carry unemployment insurance.  It is mandated just like health insurance. If a German citizen suddenly finds himself or herself unemployed, their unemployment insurance kicks in and covers the cost of their “sickness fund” premium. The unemployed are still covered for healthcare during their

time of unemployment. In the event a German citizen is unable to work, or unable to find work, and becomes poor, sickness fund premiums are paid by the government. The children of the poor continue to be covered by their parents’ plans because the plans are funded by the government.  If one is elderly and retired, their pension fund pays for the sickness fund.  As a result of all of these plans, there is one hundred percent universal coverage in Germany.

     Illegal immigrants are also covered for healthcare in Germany.  It is the position of the governments that once one is in Germany via legal or illegal means and chooses to stay, that individual has the right to access all social services that German citizens can access.

     The 200 “sickness funds” or public plans available are all non-profit.  Germany has a completely separate for-profit insurance industry.  One can move out of a public plan and   into a private plan.  However, there is a higher income requirement to do so, and you cannot move back into the public sector for coverage unless your income falls below the poverty line.  Interestingly, Reinhardt explains that 90% of all Germans are in public plans and stay in them. Only 10 percent of the German population is in a for-profit

plan even though many more are entitled to choose from a for-profit plan but do not.

     Germany’s healthcare system is a very efficient one, according to Reinhardt.  The administrative costs are much lower there because of the direct relationship of the patient and the doctor. When a patient goes to the doctor, the patient pays a small co-pay (approximately $20) for the first visit in each quarter. If the patient has more visits during that quarter, there are no more co-pays. All billing in Germany’s healthcare system is electronic.  The patient hands the physician his/her insurance card, the doctor codes in the services provided, the card is swiped, and two weeks later the physician receives payment for the service from the insurer.  There are rarely long waits for any level of healthcare in Germany.

     Drug prices are controlled in Germany by a system known as “reference pricing.” The public (sickness funds) and private plans group drugs into therapeutic categories. Patients are allowed to choose less expensive drugs that are covered under their plan or pay the difference between the cost of the covered drug and a more expensive option they want. Drug costs are kept low in Germany since most patients select the covered and less expensive drug if it works.

     Germany has a healthcare system that seems almost ideal.  All Germans are covered, all those coming into Germany (legally or illegally) and wishing to stay are covered, and Germans get to select the system of coverage they want. They have an investment in their care since they pay for half of their premiums if they are employed.  If they are unemployed for any length, their required unemployment insurance pays for their health insurance premium.  If they are poor, the government pays for their insurance.  If they are retired, their pension pays for their insurance. All children are covered under their parents’ plans. There are no long waits to see a doctor, and the doctor is promptly paid by the insurance company with possible co-pay being the only money a patient pays beyond their premium. The Germans appear to understand how to effectively implement universal health care coverage.

http://prescriptions.blogs.nytimes.com/2009/09/29/health-care-abroad-germany/

Emily Crigger

12:25PM

2/25/13