Healthcare in Germany

the last international healthcare system we covered Singapore got a great response from all of you this week we head back to Europe specifically we're going to Germany their universal health care system is based on the principles of Bismarck which say that the state should provide only for those unable to provide for themselves it's a private insurance system and it's the topic of this week's healthcare triage health insurance is mandatory in Germany everyone asked to get it before 2009 some of the richest people in Germany could choose not to buy insurance but that's no longer the case insurance is sold only by nonprofit private companies there are more than 130 of them and they're also known as sickness funds there's statutory health insurance or shì or voluntary private health insurance or pH I pH I cover some of the benefits that Shi doesn't but most are minor it also gets you access to some better amenities and cover some co-pays for other services 86% of Germans are covered by Shi and 11% by pH I as with other Universal systems the insurance is pretty comprehensive coverage includes preventive services hospitalizations outpatient visits prescription drugs mental health dental care I care rehab hospice care physical therapy even sick leave is covered long-term care is covered by a different insurance but that's mandatory too there are limits to this though and some people buy supplemental private long-term care insurance any employed citizens and pensioners who make less than fifty two thousand two hundred euros a year and their dependents are covered by Shi anyone who makes more than that or who is self-employed can choose to get the Shi or by pH I about three-quarters of people choose the Shi path there used to be no co-pays for Shi but some were added in 2004 they were about 10 euros for a doctor's visit but in 2013 most of those were removed again there are still co-pays five to ten euros for prescriptions but lots of drugs are still free ten euros a day for hospitalizations and five to ten euros for medical aids deductibles can vary by plan there's no cost sharing at all for kids and a Kaplan out-of-pocket payments at two percent of household income that number is 1% if you have a chronic illness out-of-pocket spending accounts for just over 13% of all health care spending in Germany making it slightly less than Canada comparable to the u.s. but much more than France about 72 percent of healthcare spending is public spending and just over 57 percent comes from Shi employees or pensioners pay and 8.2 percent tax in their wages up to forty seven thousand two hundred fifty euros wages above that are exempt from the axé employers contribute an additional 7.3 percent tax the contributions are all put together and then spread out amongst the nonprofit Shi funds if a fund runs low on money it can charge the members a bit extra in 2011 13 of the 156 funds did so to the tune of about a hundred to 180 euros a year phis are considered private health spending there were 42 of them in 2011 slightly more than half of them are for-profit the other slightly less than half are nonprofit the premiums are risk based on training to the program meaning that older and sicker people pay more employers make contributions to phis they do for shi but the employee contribution is higher ph is still tightly regulated by the government to protect consumers though laws also encourage competition between the funds doctors belong to regional associations which negotiate contracts with the various sickness funds outpatient Doc's work in private practice for the most part with 60% in solo practices 25% in dual practices and the rest in group practices mid-level practitioners like physician assistants are also employed in most offices about half of physicians and Shi programs or family Doc's and about half are specialists patients can choose any primary care physician specialist or Hospital that they like there's no real gatekeeping mandate meaning that people can go to see specialists without first getting the permission of their primary care doctor although some funds do offer them and offer incentives for using those gatekeeping functions a relatively small number of people do though most Doc's work in a fee-for-service way based on negotiated rates there are preset maximum numbers of patients per practice as well as reimbursement points per patient this means that there are limits on the number of patients a number of treatments for which a doc can be paid each year if a doctor goes over they may not be paid about half of all hospital beds are in nonprofit public hospitals an additional third or in private nonprofit hands the rest are for profit and that percentage has been growing most hospitals salary doctors who don't also work in the outpatient setting the federal Joint Committee decides what to cover and how to define quality the Institute for applied quality improvement and research in health care is responsible for quality assurance hospitals are mandated to report on any seven indicators so that they can be publicly compared the country tries to control costs in a number of ways there are a number of voluntary insurance schemes to do better disease management Germany uses reference pricing with respect to drugs to try to get citizens to choose cheaper options basically that means that the insurance will pay the amount of a cheapest drug in a class and if patients want a more expensive one they have to pay the difference themselves a lot of research goes into deciding which drugs are most cost effective finally regional budgets are used to hold down spending for instance if a doctor goes over what's expected for prescriptions for their patients they are held financially liable in 2011 Germany spent four thousand four hundred and ninety five dollars per capita on health care or about eleven point three percent of GDP that puts it on par with France it's expensive except for the u.s. which is insane at eight thousand five hundred and eight dollars per capita and 17.7 percent of GDP but unlike some other countries Germans have great access more than three-quarters of Germans are able to get same day or next day appointments with their doctor putting them at or near the top of the developed world quality is generally good life expectancy at birth is eighty-one years making them 24th in the world that's behind Singapore at eighty four Canada at eighty two point five in France and eighty two point three but ahead of the UK at eighty one in the u.s. at seventy nine point eight in infant mortality it beats most if not all of those countries Germany has an above average number of physicians and nurses they have a below average number of CT and MRI scanners the preventable mortality rates are well below a CD average a 2012 study found that Germany outperforms the United States and sometimes the UK in preventing death it loses to France though downsides because doctors are spread out so much there can be gaps and knowledge about what patients have and what's been done surprisingly for Germans it's somewhat inefficient the fee-for-service model encourages more care which some think goes too far and some doctors hate the system which can penalize them for doing too much Germans worry that differences in physician salaries may lead to a primary care shortage in the future self-employed people also pay a lot for care since they responsible both for the employer and employee contribution finally some claim that systems that employ tiers of coverage specifically the Shi and the pH I often lead to the wealthy doing much better than the not wealthy it's worth noting that the vast majority of people choose the Shi option what keeps the public and the private option so close in terms of quality costs and benefits likely it's the German government and there's a lot to be said for it

Channel: Healthcare Triage

Views: 361,812

Rating: 4.9289188 out of 5

Keywords: healthcare, germany, phi, shi, insurance, managed care, health, health care, doctor, specialist, hospital, inpatient, outpatient, deductible, premium, co-pay, aaron carrol

Id: NdarqEbDeV0

Length: 7min 27sec (447 seconds)

Published: Mon Jul 28 2014

Reddit Comments

[u/Ortho-Apologia]

I like health triage. Hope they make another healthcare system video, but I doubt they will.

[u/DMC_II]

Imo the best and most applicable for us in the US by far.

[u/Chrisovalantiss]

Let’s not forget the current government has made hospitals way less accessible