Chapter 8
GERMANY
Chapter 12: Overview
• Country Description
• Brief History of the Healthcare System
• Description of the Healthcare System
• Evaluation of the Healthcare System
• Emerging Challenges
• Conclusion
Country Description
• History
• Size and Geography
• Government and Political System
• Germany in the European Union
• Macroeconomics
Country Description
• Demographics
– Birth Rates
– Life Expectancy and Age Distribution
• Educational System
• Culture and Religion
• Mortality and Morbidity in the Country
Brief History Of The Healthcare
System
• Historical Evolution of the Healthcare System
– German Industrialization and the National Health
Insurance Act of 1883
– Social Conflict and the Strengthening of the
Medical Profession
– Hitler’s Third Reich and World War II
– The Post-War Period and Two German States
Brief History of the Healthcare System
• 1883 Health Insurance Act
• Strengths and weaknesses
Brief History of the Healthcare System
• Pre-World War II
– Sickness fund
– Compulsory insurance
– Evolution of the modern system
Brief History of the Healthcare System
• Pre-World War II
– National Health Insurance Act of 1883
– Hitler’s Third Reich and WWII
Brief History of the Healthcare System
• Since World War II
– Division of the country
• Federal Republic of Germany
– Reunification
– Post-unification health reform
Description of the Current Healthcare
System
• Solidarity and Subsidiarity: Basis for the
German Healthcare System
– Equity and justice
– Solidarity and subsidiarity
Description of the Current Healthcare
System
• Facilities
• Workforce
• Technology and equipment
Evaluation Of The Healthcare System
• Cost
– Multiparty Payer System and Third-Party
Distribution
– Out-of-pocket payments
– Sickness fund membership
– Current benefits
Evaluation Of The Healthcare System
• Quality
– Population measures
– Infant Mortality
– Two-Tiered Healthcare Systems (by Income)
– Vaccination Coverage
Evaluation Of The Healthcare System
• Quality Assurance
• Patients’ Rights
• Access
– Equity and Universality
– Uninsured Populations
Current and Emerging Issues and
Challenges
• Cost containment
– Financing and providing access to health
irrespective of means to pay is being tested
• Aging population
– People between 33 and 54 are most
concerned; they have to pay for themselves
and for their retired fellow Germans
• Refugee Crisis
Conclusion
• German Health Care System (GHCS) based on
the original “Bismarck” model of healthcare
– Equity and Universal coverage
– Ready access with free flexible choices
– Funded by government and private contributions
• Healthcare is better than in most countries, but
patients are facing increasing costs
Conclusion
• Population aging and the increasing prevalence
of lifestyle-related chronic diseases expected
to boost health care demand
• Plans underway to implement health care cost
containment and process optimization
– Value-based pricing models and
– Pay-for-performance mechanisms
This Section Reserved
for Instructors
Suggested Discussion or Research
Questions
General Question Categories
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Structure and Evaluation Healthcare Services and Systems
Global Burden of Disease
Cultural Influences
Medical Travel and Tourism and Off Shoring
Health Communication, Marketing, Social Marketing
Data and Measurement
Policy, Strategy, and the Regulatory Environment
Global Health Leadership
International Best Practices
Discussion or Research Questions
• Describe the strengths and weaknesses of the German
healthcare system.
• What were the underlying reasons for the development of the
Bismarck System of social welfare?
• What improvements were made in the social and health
insurance system in the years immediately before World War
II?
• Compare and contrast the Bismarck System of social and
health delivery in West Germany and the centralized, state
financed system developed in East Germany.
Discussion or Research Questions
• Describe the key provisions of the German health reform law
passed in 2007.
• Describe the two fundamental principles that underpin the
German healthcare system.
• What impacts on healthcare service delivery are associated
with the presence of a two-tiered health insurance system?
• How have recent health reforms affected individual financial
responsibility in Germany?
Suggested Topic Areas To Use When Facilitating
Discussions, Projects, or Case Studies
• Engagement of stakeholders
• Effectively working in and managing teams
• Learning how to get in front of the problem or identify
opportunities
• Learning to communicate effectively
• Assessment of solutions that fit the country
• Embracing systems thinking
• Recognize and embrace diversity
• Sustaining the mission of health as well as health care
Links to Suggested Images
• http://moscow-consulting.com/publications/how-can-state-financedhospitals-increase-their-extrabudgetary-funding
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