The document provides an overview of the German healthcare system. It describes how the system is based on both public and private insurance, with public insurance covering around 88% of the population. Public insurance is funded through income-related contributions from employers and employees. The system aims to provide equal coverage to all citizens regardless of income or age. It covers a wide range of medical services and utilizes various strategies to ensure quality of care and reduce disparities.
4. Originally designed for the
reunification of Germany in
the
19th Century
Similar to the type of
healthcare you would see in
the USA
except that the Bismarck
model is paid for by
employers
that often do payroll
deductions to pay for the
insurance
5. overview
The German healthcare system is one of the oldest healthcare systems in the world,
dating back to 1880s. The system is organized into two major divisions:
Public
insurance
Private
insurance
German
healthcare
system
The German public health care system is based on the principle of
solidarity.
6. Understanding the German healthcare system
The most important thing to know about the German health care system is that it is
mandatory. All nationals and temporary residents in Germany have to pay for health insurance
every month. The cost of health insurance in Germany comes down to two main factors:
Your income and employment status.
Whether you are paying for Public or Private health insurance.
7. Characteristics
Public or statutory insurance
◦ Cost:the higher your salary, the more you will
have to pay for health insurance
◦ Your employer pays half of your contributions:
◦ Equal coverage: Just because people with higher
salaries pay more, it does not mean that they
have better coverage. Everyone has equal
coverage, regardless of their income or age.
Private insurance
◦ It can be cheaper if you are young and healthy
◦ It is more expensive the older you are
◦ You may not be covered for pre-existing
conditions
◦ You may not be able to get back on public health
insurance
◦ You have to choose what you want covered
8. More on public insurance
◦ You can include your dependents on your own insurance: If you have children or your spouse is
unemployed (or has a low income), then you can include them on your own health insurance
with no additional cost.
◦ Who can opt-out: If your income is above a certain amount (appx. € 59,000 per year), then you
can opt-out of public health insurance and obtain private health insurance instead. If your
annual income is less than € 59,000, then you must get public health insurance.
◦ 59,000 EURO = 5176217.89 INR
◦ Long-term care services are covered separately under Germany’s
mandatory, statutory long-term care insurance (LTCI).
9. ROLE OF PLAYERS
The statutory health insurance (SHI) system consists of 110 sickness funds (acting as third-party payers) covering around
88% of the population. The self-employed and employees who exceed a certain income threshold may choose to stay
with SHI or opt for private health insurance (PHI) provided by 41 insurance companies. PHI covers around 10% of the
population, including civil servants; the remainder (e.g. military) are covered through special schemes. An estimated
0.1% of the population, however, does not have insurance due to administrative hurdles or problems paying premiums
SHI is financed mostly through income-related contributions equally shared between employer and employees.
Contributions are pooled in a central fund and reallocated to sickness funds based on the health needs of their
constituents. PHI is financed through premiums defined by individual health risk upon entry (“life-time underwriting”)
10.
11. CONTINUED..
◦ Role of government: The German health care system is notable for the sharing of decision-
making powers among the federal and state governments and self-regulated organizations of
payers and providers
◦ Role of public health insurance: In 2017, total health expenditures made up 11.5 percent of the
gross domestic product (GDP). Of this health spending, 74 percent was publicly funded, and
most of that spending (57% of total) went toward SHI
◦ Role of private health insurance: In 2017, private health insurance accounted for 8.4 percent of
total health expenditures
12. SERVICES COVERED UNDER SHI
◦ Preventive services, including regular
dental checkups, child checkups, basic
immunizations, chronic disease
checkups, and cancer screenings at
certain ages
◦ Inpatient and outpatient hospital care
◦ Physician services
◦ Mental health care
◦ Dental care
◦ Optometry
◦ Physical therapy
◦ Prescription drugs, except for those
explicitly excluded by law
◦ Medical aids
◦ Rehabilitation
◦ Hospice and palliative care
◦ Maternity care
◦ Sick leave compensation.
13. HOW IS THE DELIVERY SYSTEM
ORGANIZED AND HOW ARE
PROVIDERS PAID?
14. Physician education and workforce: About 35 public universities and five private ones offer degrees in
medicine. Studying at public universities is free, while private institutions sometimes require tuition fees
Primary and outpatient specialist care: General practitioners (GPs) and specialists in ambulatory care
typically work in their own private practices. Most physicians working in multispecialty clinics are salaried
employees
Administrative mechanisms for direct patient payments to providers: Copayments or payments for services
not included in the SHI benefit package are paid directly to the provider. In cases of private health
insurance, patients pay up front and submit claims to the insurance company for reimbursement
15. Mental health care: Acute psychiatric inpatient care is provided largely by psychiatric wards in general (acute)
hospitals. The number of hospitals providing care only for patients with psychiatric and/or neurological illnesses is
low
Long-term care and social supports: Statutory LTCI is mandatory. People typically get statutory LTCI from the same
insurers that provide SHI. Employees share the contribution rate of 3.05 percent of gross salary with their
employers; people without children pay an additional 0.25 percent
After-hours care: After-hours care is organized by the regional associations to ensure access to ambulatory care
around the clock. After-hours care assistance is available mainly through a nationwide telephone hotline
Hospitals: Public hospitals make up about half of all beds, while private not-for-profits account for about a third. The
number of private, for-profit hospitals has been growing in recent years
17. Quality of care is addressed through a range of measures broadly defined by law and in more detail by the
Federal Joint Committee
The Institute for Quality Assurance and Transparency (IQTiG) is responsible for measuring and reporting on
quality of care and provider performance on behalf of the Federal Joint Committee
In addition, the institute develops criteria for evaluating certificates and quality targets and ensures that
the published results are comprehensible to the public
All hospitals are required to publish findings on selected indicators, as defined by the IQTiG, to enable
hospital comparisons
The results of these quality checks are published in transparency reports
Disease management programs ensure quality of care for people with chronic illness
Nonbinding clinical guidelines are produced by the Physicians’ Agency for Quality in Medicine and other
professional societies
19. Strategies to reduce health
disparities are delegated
mainly to public health
services, and the levels at
which they are carried out
differ among states
A network of more than 120
health-related institutions,
including sickness funds and
their associations, promotes
the health of the socially
deprived
Primary preventive care is
mandatory by law for
sickness funds
21. Since 2015, electronic medical chip cards have been used nationwide by all
the SHI-insured
they encode information including the person’s name, address, date of birth,
and sickness fund, along with details of insurance coverage and the person’s
status regarding supplementary charges
In 2015, Parliament passed a law for secure digital communications and
health care applications
SHI physicians receive additional fees for sharing electronic medical reports
with other providers (since 2016–2017)
23. • The Hospital Care Structure Reform Act of 2016 aims
not only to link hospital payments to good service
quality but also to reduce payments for low-value
services
• To enhance competition, some purchasing power has
been handed over to the individual sickness funds
instead of relying on collective contracts with regional
associations
• All drugs, both patented and generic, are placed into
groups with a reference price serving as a maximum
level for reimbursement, unless an added medical
benefit can be demonstrated
25. Conclusion
Germany seems to have an utterly well-organized system, where help, care, prescription drugs or
surgery is guaranteed when needed. This method is used in many European countries
India saw its crisis several years ago and started projects to improve the situation and tried to
offer everybody the care they needed, similar as in European countries. Since average income in
India is very low and big parts of the population live below the international poverty line, the
government and the provinces have to raise the incidental costs themselves
RSBY - Rashtriya Swasthya Bima Yojana
The RSBY is an Indian mission, launched in 2008. Rashtriya Swasthya Bima Yojana, the Indian
name for this project can be translated to National Health Insurance Program. The main idea of it
is to cover a specific amount of the medical fees for the poorest parts of the population
