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[SOLVED] Germany’s Health Care/Gleckman Study

Please use research that was compiled with the added references and information for the research this week for a comparative analysis to the US health care system highlighting the advantages and disadvantages Germany’s health care system.  References  Carrera, P., Siemens, K., and Bridges, J. (2008). Health Care Financing Reforms in   Germany: The Case for Rethinking the Evolutionary Approach to Reforms.   Retrieved on August 5, 2012 from  /pdfviewer?vid=4&hid=105&sid=a42a37df-6132-45e6-9e94-8495fc9f5b45  %40sessionmgr110  Health Care Providers in Germany. (1998). German Culture. Retrieved from   Health Insurance in Germany. (1998). German Culture. Retrieved from   Health Insurance Options in Germany. (2012). How to Germany. Retrieved from   Kock, K., Schurmann, C., and Sawicki, P. (2010). The German Health Care System   in International Comparison. Retrieved on August 5, 2012 from  Gleckman, H. (2007). Financing Long Temr Care: Lessons from Abroad. Retrieved from Center for Retirement at Boston College:  Gleckman, H. (2010, February). LONG-TERM CARE FINANCING REFORM:. Retrieved from The Urban Institute: Germany’s Health Care System  Germany has the oldest universal health care system in the modern world. Otto von Bismarck founded this social insurance system at the national level in 1883. The principles of the system are identified as solidarity, subsidiarity, and corporatism (Clarke, 2012). Solidarity means that the government is responsible for ensuring everyone is able to access health care, and it does so by helping those who cannot participate in private health insurance. This system is viewed as a social partnership (Clarke, 2012).  Subsidiarity refers to a decentralized system in which policies are established by the smallest political unit, and this is actually part of the country’s constitution. In terms of health, subsidiarity means that the government only sets the legislative framework and establishes a bargaining process. Corporatism is reflected with both employers and employees being represented on governing boards of “sickness funds.” Sickness funds are comprised of approximately 240 nonprofit insurance companies (Clarke, 2012; Knox, 2008). There are national and regional groups that make decisions about rules and fees (Clarke, 2012).  Payroll taxes pay for this health care system—the tax is 15.5% of gross income. Of that, 8.2% is paid by the employee and 7.3% is paid by the employer. Unemployed people also pay if they are receiving unemployment benefits (Clarke, 2012). This proportional tax rate reflects the solidarity principle—if you make more, you pay more, but everyone receives the same services. Sometimes a small co-payment is required, but that is limited to 2% of the family’s annual income or 1% for those who have chronic illnesses (Clarke, 2012). The chronically ill do not have to contribute toward any prescription drugs, and there are never any deductibles.  Access is universal. A German citizen or long-time resident may go to any doctor or any specialist of his or her choice. No referrals are required for specialists. The spiraling costs of health care have led to drastic changes since 2009. It is a law that Germans must have health insurance. Those who earn less than €49,500 can obtain health care coverage provided by the public statutory health insurance scheme (SHI). Entire families are insured under this scheme (Clarke, 2012). Those who earn more than €49,500 may opt to purchase a private plan, but most stay with SHI. Perhaps that is because once they make that switch, they can never again return to SHI.  The only limitation to SHI is that the doctor or dentist must be recognized by the sickness funds; more than 90% are. All physicians must join an association that monitors physician performance and controls the physician payment system (Clarke, 2012). People can choose their own doctor or hospital and refer themselves to specialists, and most will find there are rarely long waiting times for elective surgery (Knox, July 3, 2008).  Physicians are paid through the sickness funds on a fee-for-service basis that is established in each region. The government has predetermined price schedules. Since the 1990s, German citizens have been able to select one of several health care insurers. They are also permitted to switch health care insurers once every 12 months. Germany’s health care system offers a broad array of comprehensive services that include: preventive services, physicians, inpatient and outpatient hospital care, mental health care, prescription drugs, rehabilitation, sick leave compensation, and domestic nursing care (Clarke, 2012). Long-term care was added in 1995, and it has a separate payroll tax.  Private health care insurers may cover co-payments and expenses that public insurance does not; for example, dental costs or upgrading to a private hospital room (Clarke, 2012). These are supplementary plans rather than substitutive plans—the patient is still covered primarily by SHI. There are separate premiums for these plans and patients are assessed for risk before such a plan is approved by the insurer (Clarke, 2012). However, there are some federal law restrictions, insurers may not reject a patient for preexisting conditions and the policy is for life. Health care systems across the world are becoming dramatically more expensive; however, Knox (July 2, 2008) reported that the German system has one of the world’s most successful systems, insofar as it provides quality care for everybody and it spends less than many other countries. The system provides physicians, specialists, dentists, prescriptions, hospital care, and long-term care. Germany attempts to control costs by keeping doctors on a budget. Doctors in hospitals are on salaries—negotiated each year—that are part of the hospital’s comprehensive budget. The 240 sickness funds cover about 90% of German citizen’s health care cost (Knox, July 2, 2008). Physicians who have their own offices are entrepreneurs who are paid by their patients or by insurance companies. Regions negotiate with insurers for annual budgets. Money for doctors is divided into quarterly amounts, and when that is gone, the doctors do not receive more money until the next quarter (Knox, July 2, 2008). The outcomes seem negative but the negotiation process with insurers does keep doctors on a budget and prevents some of them from providing services that are not needed. On the other hand, this plan could discourage doctors from providing necessary services because they will not be paid for those services. Most doctors find that by the end of each quarter, they haven’t been pain in two or three weeks, and then there are those who just go on vacation. People living in Germany who are familiar with both the German and American health care systems say that the German system is far better. People would never go bankrupt in Germany because of medical bills (Knox, July 3, 2008). A woman who is from San Diego but is married to a German citizen, lives in Germany, and has a good annual income, reports that she pays $270 per month and that plan covers her children. She says she pays one $15 co-pay every three months for her physician and one $15 co-pay every three months to see her specialist—that’s all. There are no co-pays for her children, not even for her daughter’s orthodontia (Knox, July 3, 2
008). Furthermore, she says the care has always been excellent.  Over the last several years, Germany has enacted many reforms to assure the financial sustainability of its universal health care system. It has increased compulsory contributions, and this rate is fixed by legislation (Clarke, 2012). Members of the statutory health insurance committee will finance changes that are unavoidable, such as an aging population or advancing technology. Premiums that are not related to income will be charged (Clarke, 2012). Individual health insurance funds will set these premiums. Steps have been taken to ensure that contributors will not be overburdened by the premiums.

References  Clarke, E. (2012). Health care systems: Germany. Based on the 2001 Civitas report by David Green and Benedict Irvine. Updated 2012. Retrieved from  European Commission. (2011). Germany national reform programme 2011. Retrieved from  Knox, R. (2008, July 2). Keeping German doctors on a budget lowers costs. Retrieved from NPR  Knox, R. (2008, July 3). Most patients happy with German health care. Retrieved from NPR

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