Healthcare System
Germany vs. United States
Germany vs. United States
A Comparison of Healthcare Systems
Deborah Glen
Grand Canyon University
Healthcare Systems and Transcultural Healthcare
January 8, 2011
Comparing Healthcare Systems between Germany and the United States
The chart included here compares healthcare systems between Germany and the United States. Though many miles apart geographically, there are many similarities between the two nations. Many people and institutions, both government and non-government, form Germany’s healthcare system, termed Socialized Health Insurance by our text (Shi & Singh, 2010). Almost everyone is eligible. 88% subscribe to mandatory health insurance, 9% private insurance, 0.7% public insurance …show more content…
(police and fireman), and 1.6% are covered through welfare leaving just 0.1% of German nationals without any coverage at all (Rychlik, et al, 2000). Coverage is paid by monthly fees to insurance companies, with a very small percent subsidized by the government. All insured people pay some percentage of their income as premiums and everyone is assured of equal care, no matter how much they pay in. A “Principle of Equality” (Paola, et al, 2010) exists, meaning that the financially secure help pay for the poor and needy, young pay for old, singles pay for families. The premiums are based only on income and ability to pay. Employers pay 50% of their employee’s fees. An association of caregivers negotiates a budget with the insurance companies and then divides the money amongst the members of the association according to their individual number of patients. Before 1989, the healthcare system of the Former German Democratic Republic (East Germany) was under the control of the state. As a result there was no insurance necessary for the people. When the wall fell, the West German system was introduced to the East. Such radical change caused many of the East German health insurances to face bankruptcy by 1999 and consequently West German companies have been found liable for the financial shortfall estimated at close to $130 million by 2014 (Rychlik, et al, 2000). To help offset this debt, managed care has been presented as a possibility in healthcare reform in Germany. Though still in its infancy, already certain changes are being looked at more closely, as they are foreign to what the German people have come to know about health care. These include: division of labor to ensure that defensive medicine is not being practiced, new and better quality assurance, better coordination between in-patient and out-patient care, and producing a new program toward preventative medicine and personal responsibility towards health and well-being. In contrast, the United States health care system is privately owned, voluntarily funded or paid for by premiums and taxes.
Employment based, Government funded, and Private Pay Health Insurance is the most common type of coverage. Workman’s Compensation is Government funded with a portion of the funds coming from employers. Also, separately funded, is the Military Medical Care system, caring for active, discharged, retired, and families of military men and women. Approximately 60% of the American people are covered by employment based insurance, 25% are covered by Government Insurance and 16.8% are uninsured (Shi & Singh 2010). There is no central governing body to delegate fees, costs, distribution, accessibility or quality nationwide, and the system continues to focus on acute care rather than preventive or personal responsibility for health. Defensive practices are the norm due to high risks of litigation and access to care is often controlled by ability to pay or insurance …show more content…
coverage. The U.S.
is primarily a managed care system, with the government, private payers and employers as the financial backing to the Managed Care Organization (MCO), responsible for acquiring caregivers and creating the contracts through which the caregivers are paid. Here, too, there are problems noted with quality assurance, coordination of patient care and follow-up, preventive and defensive medicine, as well as accessibility due to geographic location, inequality of resources, lack of education, and lack of healthcare providers/professionals. As we move forward in the 21st Century, I feel the United States must focus more on access and cost containment. Middle-aged and low-to-middle income families and individuals, are having difficulty choosing between healthcare and groceries, or worse yet, rent. Although fighting many of the same battles, Germany, at least, can say that almost all the people living in their borders are insured and assured of comprehensive health care now, and in the immediate future.
|Comparison of Healthcare Between United States and Germany |
| | United States | Germany |
|Financing |Private, Government, Taxes, Premiums, |Government, Private, % of wages, income
|
| |Voluntary |based |
|Structure |Managed Care |Socialized, moving towards Managed Care |
|Payment (Facilities) |Per person, Private, Fee for services, MCO |Negotiated fees based on projections |
| |negotiated fee | |
|Payment (Physicians) |MCO negotiated fee, Fee for service |Negotiated fee for service, fee per person |
|Out-of-Pocket |Significant premiums plus overages |None |
|Recipients |Employed, aged, welfare, Military |Everyone |
|Accessibility |Harder for rural areas, poor, unemployed |Everyone |
|Costs |Costs increasing due in part to technology |Increasing at a lesser rate than United |
| |and Defensive medicine |States for similar reasons as well as |
| | |including restructuring to include East |
| | |Germany |
|Patient satisfaction |Overall highly satisfied, but care does not|No complaints voiced. Everyone receives |
| |reach all the intended targets due to |equal care no matter what they pay |
| |inability to pay and location | |
References
Paola, F.A., Walker, R., Nixon, L. L., (2010). Medical ethics and humanities (2nd Ed.) Sudbury, MA: Jones and Bartlett Publishers, LLC
Rychlik, R., Guntertgomann, K., Kilburg, A., & Frazier, J., (2000). Healthcare Reforms in Germany: Managed Care, An Opportunity? Disease Management & Health Outcomes, 8 (6), 305-312. Retrieved from Academic Search Premiere database January 8, 2011.
Shi, L., Singh, D.A. (2010). Essentials of the U.S. health care system. Sudbury, MA: Jones and Bartlett Publishers
Germany vs. United States
A Comparison of Healthcare Systems
Deborah Glen
Grand Canyon University
Healthcare Systems and Transcultural Healthcare
January 8, 2011
Comparing Healthcare Systems between Germany and the United States
The chart included here compares healthcare systems between Germany and the United States. Though many miles apart geographically, there are many similarities between the two nations. Many people and institutions, both government and non-government, form Germany’s healthcare system, termed Socialized Health Insurance by our text (Shi & Singh, 2010). Almost everyone is eligible. 88% subscribe to mandatory health insurance, 9% private insurance, 0.7% public insurance …show more content…
(police and fireman), and 1.6% are covered through welfare leaving just 0.1% of German nationals without any coverage at all (Rychlik, et al, 2000). Coverage is paid by monthly fees to insurance companies, with a very small percent subsidized by the government. All insured people pay some percentage of their income as premiums and everyone is assured of equal care, no matter how much they pay in. A “Principle of Equality” (Paola, et al, 2010) exists, meaning that the financially secure help pay for the poor and needy, young pay for old, singles pay for families. The premiums are based only on income and ability to pay. Employers pay 50% of their employee’s fees. An association of caregivers negotiates a budget with the insurance companies and then divides the money amongst the members of the association according to their individual number of patients. Before 1989, the healthcare system of the Former German Democratic Republic (East Germany) was under the control of the state. As a result there was no insurance necessary for the people. When the wall fell, the West German system was introduced to the East. Such radical change caused many of the East German health insurances to face bankruptcy by 1999 and consequently West German companies have been found liable for the financial shortfall estimated at close to $130 million by 2014 (Rychlik, et al, 2000). To help offset this debt, managed care has been presented as a possibility in healthcare reform in Germany. Though still in its infancy, already certain changes are being looked at more closely, as they are foreign to what the German people have come to know about health care. These include: division of labor to ensure that defensive medicine is not being practiced, new and better quality assurance, better coordination between in-patient and out-patient care, and producing a new program toward preventative medicine and personal responsibility towards health and well-being. In contrast, the United States health care system is privately owned, voluntarily funded or paid for by premiums and taxes.
Employment based, Government funded, and Private Pay Health Insurance is the most common type of coverage. Workman’s Compensation is Government funded with a portion of the funds coming from employers. Also, separately funded, is the Military Medical Care system, caring for active, discharged, retired, and families of military men and women. Approximately 60% of the American people are covered by employment based insurance, 25% are covered by Government Insurance and 16.8% are uninsured (Shi & Singh 2010). There is no central governing body to delegate fees, costs, distribution, accessibility or quality nationwide, and the system continues to focus on acute care rather than preventive or personal responsibility for health. Defensive practices are the norm due to high risks of litigation and access to care is often controlled by ability to pay or insurance …show more content…
coverage. The U.S.
is primarily a managed care system, with the government, private payers and employers as the financial backing to the Managed Care Organization (MCO), responsible for acquiring caregivers and creating the contracts through which the caregivers are paid. Here, too, there are problems noted with quality assurance, coordination of patient care and follow-up, preventive and defensive medicine, as well as accessibility due to geographic location, inequality of resources, lack of education, and lack of healthcare providers/professionals. As we move forward in the 21st Century, I feel the United States must focus more on access and cost containment. Middle-aged and low-to-middle income families and individuals, are having difficulty choosing between healthcare and groceries, or worse yet, rent. Although fighting many of the same battles, Germany, at least, can say that almost all the people living in their borders are insured and assured of comprehensive health care now, and in the immediate future.
|Comparison of Healthcare Between United States and Germany |
| | United States | Germany |
|Financing |Private, Government, Taxes, Premiums, |Government, Private, % of wages, income
|
| |Voluntary |based |
|Structure |Managed Care |Socialized, moving towards Managed Care |
|Payment (Facilities) |Per person, Private, Fee for services, MCO |Negotiated fees based on projections |
| |negotiated fee | |
|Payment (Physicians) |MCO negotiated fee, Fee for service |Negotiated fee for service, fee per person |
|Out-of-Pocket |Significant premiums plus overages |None |
|Recipients |Employed, aged, welfare, Military |Everyone |
|Accessibility |Harder for rural areas, poor, unemployed |Everyone |
|Costs |Costs increasing due in part to technology |Increasing at a lesser rate than United |
| |and Defensive medicine |States for similar reasons as well as |
| | |including restructuring to include East |
| | |Germany |
|Patient satisfaction |Overall highly satisfied, but care does not|No complaints voiced. Everyone receives |
| |reach all the intended targets due to |equal care no matter what they pay |
| |inability to pay and location | |
References
Paola, F.A., Walker, R., Nixon, L. L., (2010). Medical ethics and humanities (2nd Ed.) Sudbury, MA: Jones and Bartlett Publishers, LLC
Rychlik, R., Guntertgomann, K., Kilburg, A., & Frazier, J., (2000). Healthcare Reforms in Germany: Managed Care, An Opportunity? Disease Management & Health Outcomes, 8 (6), 305-312. Retrieved from Academic Search Premiere database January 8, 2011.
Shi, L., Singh, D.A. (2010). Essentials of the U.S. health care system. Sudbury, MA: Jones and Bartlett Publishers