health care system of germany

1. Health care system of
Germany
Deepak belbase (107)
Sarita Dhakal (115)
Sworim Bajracharya (118)

2. Introduction
• The Federal Republic of Germany is in central Europe, with 81.8
million inhabitants (December 2011), making it by some distance the
most populated country in the European Union (EU). Berlin is the
country’s capital.
• In 2012 Germany’s gross domestic product (GDP) amounted to
approximately €32 554 per capita (one of the highest in Europe).
Germany is a federal parliamentary republic consisting of 16 states
(Länder)
• By 2010, life expectancy at birth in Germany had reached 78.1 years
for men and 83.1 years for women

3. Health care system
• In Germany, health care is based on a decentralized and self-
governing system run by a number of different players.
• The German health care system is divided into three main areas:
outpatient care, inpatient care (the hospital sector), and
rehabilitation facilities.
• The institutions responsible for running the health care system
include the associations and representatives of various providers and
professions, health insurers, regulatory bodies and the Federal
Ministry of Health.

4. The basic principles of the health care system
The health care system in Germany is based on four basic principles:
• Compulsory insurance: People generally must have statutory health
insurance provided that their gross earnings are under a fixed
threshold. Anyone who earns more can choose to have private
insurance
• Funding from premiums: Health care is financed mostly from the
premiums paid by insured employees and their employers. Tax
revenue surpluses also contribute

5. • Principle of solidarity: In the German health care system, statutory
health insurance members mutually carry the individual risks of loss
of earnings and the costs of medical care in the event of illness.
Everyone covered by statutory insurance has an equal right to receive
care – regardless of their income and premium level. Premiums are
based solely on income. This means that the rich can help the poor,
and the healthy can help the ill.
• Principle of self-governance: While the state sets the conditions for
medical care, the further specific setup, organization and financing of
individual medical services is the responsibility of the legally
designated self-governing bodies within the health care system.

6. Structure and institutions of the health care system
• The Federal Ministry of is responsible for policy-making at the federal level.
It is their task to develop laws and draw up administrative guidelines that
establish the framework of the self-governing activities within the health
care system.
• When it comes to matters concerning statutory health insurance, the
Federal Joint Committee is the highest decision-making body within the
self-governing health care system. It includes members representing
doctors, dentists, psychotherapists, the statutory insurers, hospitals and
patients.
• The Federal Joint Committee is also responsible for health care quality
assurance, and is supported in this role by - among others - the Institute for
Quality and Efficiency in Health Care

9. • Since 2009, health insurance has been mandatory for all citizens and
permanent residents, either through Statutory Health Insurance (SHI)
or private health insurance (PHI). SHI covers 85% of the population –
either mandatorily or voluntarily.
• In 2012, the percentage of the population having cover through such
PHI was 11%.
• Additionally, 4% of the population is covered by sector-specific
governmental schemes (e.g. for the military).
• Total health expenditure was €300.437 billion in 2012, or 11.4% of
GDP (one of the highest in the EU).

10. • In 2012, there were 2017 hospitals with a total of 501 475 beds (6.2
beds per 1000; higher than any other EU country). Of these, 48% of
beds were in publicly owned hospitals, 34% in private non-profit and
18% in private for-profit hospitals.
• The average length of stay decreased steadily between 1991 and
2011, falling from 12.8 to 7.7 days.
• According to the WHO Regional Office for Europe’s Health for All
database, 382 physicians per 100 000 were practicing in primary and
secondary care.

11. Basic mechanism of SHI and PHI

13. • Public health is principally the responsibility of the Länder, covering
issues such as surveillance of communicable disease and health
promotion and education.
• Governmental policy since the early 2000s has principally focused on
cost-containment and the concept of a sustainable financing system.

14. Conclusion
• In the German health care system, decision-making powers are
traditionally shared between national (federal) and state (Land)
levels, with much power delegated to self-governing bodies.
• It provides universal coverage for a wide range of benefits.
• Characteristics of the system are free choice of providers and
unrestricted access to all care levels.
• A key feature of the health care delivery system in Germany is the
clear institutional separation between public health services,
ambulatory care and hospital (inpatient) care.

15. Strength and limitations
• In international terms, the German health care system has a generous
benefit basket, one of the highest levels of capacity as well as
relatively low cost-sharing.
• However, the German health care system still needs improvement in
some areas, such as the quality of care.
• In addition, the division into statutory and private health insurance
remains one of the largest challenges for the German health care
system, as it leads to inequalities.

16. THANK - YOU