Comparative European Politics
The German Health Care System
Reading Germany: Applied
Christianity, in TR Reids The Healing of America
Describe the German
System
How are people insured?
By whom?
Who pays? How?
Bismarkian or Beveridge Model??
The Bismarkian
Model
He invented it!
Named for Otto
von Bismarck
The Iron
Chancellor
Unifier of the
modern German state (1862)
An innovator,
nationalist (Prussian)
Ironic that he
invented the modern welfare state
But was hardly a
humanitarian
Political
motive: to win the allegiance of
the working class
Christian/Lutheran
Influence
Charity a
Christian duty
Urged people to view
his welfare state as a program of applied Christianity
The
greatest burden for the working class is the uncertainty of life. They can never be certain that they
will have a job, or that they will have health and the ability to work. We cannot protect a man from all
sickness and misfortune. But it is
our obligation, as a society, to provide assistance when he encounters these
difficulties.A rich society must care for the poor (Bismark, quoted in Reid, 74).
1883 Sickness
Insurance Law
Created the worlds
first national health care system
Mandatory medical
insurance
Premiums paid jointly
by employers and workers
Coverage Today
All residents of
Germany, legal or not
Benefits
Generous
Covers doctors,
dentists, chiropractors, physical therapists, psychiatrists, hospitals,
opticians, all prescriptions, nursing homes, health club memberships, spa
vacations (when recommended by a physician)
Quality of Care
High
Ranks near the
top on most measures
No queue
Ample supply of
doctors
Wait time less
than in US for emergency care, and for elective/non-emergency surgery
Cost
Today, workers
portion withheld from paycheck, a percentage of income (about 15% of their
paychecks)
Equal to what
American workers have withheld for Social Security and Medicare taxes (but
American workers also have to pay health insurance premium, 2-10% of their pay)
Co-pay *(only
ONCE per quarter) added as part of controversial 2006 reform; 10 Euros (about
$13)
Doctors
Debt free for
education
$1400/year in
medical malpractice (barely one-weeks premium for American doctors)
Dr. von Kockritz
has never been sued
Makes about
$100,000-150,000/year
Drs and other
care providers protested against the 2006 reforms (cost controls; what
treatments/prescriptions they can order; money they can earn)
Choice
Residents can
choose any doctor or hospital
But GPs do play
the gatekeeper role
Insurance must
pay all bills
Residents can
choice among 200 different, private insurance companies
Krankenkassen sickness
funds
Private vs.
Public
Insurers,
doctors, most providers are private businesspeople
Working in
private clinics
Most hospitals
are charities or municipally owned and operated
Growing number of
private, for-profit hospital chains
Insurance
companies are nonprofit entities
They negotiate
prices with the clinics; have about 1/3 the admin costs of US insurance
companies
Insurance
companies compete for your business; workers can choose (extras)
Government
controls payments to doctors and hospitals
Government pays
premiums for unemployed, no matter how long
Cost/Efficiency
More than most
European systems (except France)
Less than the US
11% of German GDP
(compared with 17% for US)
Universal smart
card
Die elektronischen
Gesundheitkarte
Gebhrenordnung fr
rtze, GOA
Negotiated by
sickness funds and doctors union (corporatism)
Lists what
procedures and treatments are covered
Discussion
Questions:
What does the
design of the German healthcare system reveal about the political culture of Germany
in the 20th and 21st centuries? That is, what values are reflected in
its healthcare system?
Does this
represent a shift in German political values compared to earlier
centuries? If not, why not? If so, what caused this shift in
values?