The document compares and contrasts the healthcare systems of Germany and the United States. It discusses how Germany's system originated from Otto Von Bismarck and is based on principles of solidarity, subsidiarity, and corporatism. The German system provides universal coverage and low costs for patients. While both countries face rising healthcare costs, Germany controls costs through regulation and negotiated drug prices. The US system has strengths like cutting-edge research but weaknesses include millions of uninsured and high costs preventing access to care. Overall, the document analyzes the structure and performance of both countries' healthcare.

1. 1
Running Head: Germany’s Healthcare system compared with the U.S
Josh Streeter
HCS 400
Germany’s Healthcare System compared with the U.S
11/25/14

2. 2
Running Head: Germany’s Healthcare system compared with the U.S
Abstract
This research paper will be discussing, comparing, and contrasting between Germany’s
healthcare system and the United States healthcare system. This paper will open up state the start
of the German healthcare system. This paper will be addressing some issues in both healthcare
systems such as cost, access for all individuals and how that differs from country to country, life
expectancy and general health status of individuals living in both countries along with strengths
and weaknesses of both healthcare systems. Finally, this research paper will be discussing some
improvements that can be made for both countries.

3. 3
Running Head: Germany’s Healthcare system compared with the U.S
The German healthcare system was started by a man named Otto Von
Bismarck. Bismarck had three main principles that he took and made his own. These three
principals were Solidarity, Subsidiarity, and Corporatism (Clark, 2012, Bidgood, 2013). First,
Solidarity is the act of all people in the country having health insurance. This can be compared to
our goal in the Affordable Care Act which is that everyone needs to have health insurance. This
also means that if you cannot afford the private insurance then you would be automatically be
put on a different type of insurance. The second principle that Otto Von Bismarck used in his
model was the principle of Subsidiarity. Subsidiarity according to Bismarck is that the
government is the only one responsible for setting the legislative framework for medical
facilities and hospitals alike (Clark, 2012, Bidgood, 2013). It is also made for establishing the
corporatist bargaining system. In laments terms, this part of the act is like the government of the
medical field they are the ones that handle all of the money and finances. They also set all of the
standards in accordance with money. The third principle that is used by Bismarck is the principle
of Corporatism. Corporatism is the elected representatives of employee and employers that
negotiate the terms of medical care that which reflect medical professionals and insurance
companies (Clark, 2012, Bidgood, 2013). These elected representatives negotiate the terms of
medical care and reflect the interests of groups such as doctors, dentists, pharmacists, the
pharmaceutical industry and insurers (Clark, 2012, Bidgood, 2013). Again in laments terms,
these people are kind of like vouchers for the people in the medical industry. They help with all
decisions of rules and regulations such as consent.

4. 4
Running Head: Germany’s Healthcare system compared with the U.S
In this next section, the content that will be presented will be about the care
of patients in Germany. The overall care for patients in this country are very well. Most of the
care for patients are done by primary care physicians who work in solo practices (Clark, 2012,
Bidgood, 2013). These solo practices can usually be found in mid-size towns or cities. This is
also where specialists can be found as well (Clark, 2012, Bidgood, 2013). There are not many
primary care facilities in Berlin, although they do have hospitals. Going along with primary care
physicians, the estimated wait time for seeing your doctor is very short (Clark, 2012, Bidgood,
2013).. Compared to the United States, where waiting times can be up to hours, in Germany they
can be as little as 10 minutes. Hospitals play a very little role with the primary care service.
Hospitals have very few out-patient services because of this. Patients get a lot of freedom under
Germany’s healthcare system. For example, patients are free to choose their physician or hospital
and can refer themselves directly to a specialist (Clark, 2012, Bidgood, 2013). The only down
side to this is that the physicians must join an association with regulates how much they get paid
and monitors physician performance (Clark, 2012, Bidgood, 2013).
This next section of the paper will be discussing cost and payment options.
Physicians are either paid for directly by the patient or their private insurance company (Clark,
2012, Bidgood, 2013). Depending on the type of treatment of the patient, the government sets up
most of the payment scales (Clark, 2012, Bidgood, 2013). Again, this has to do with the principle
of subsidiarity that Bismarck enforced which says that the government is the one responsible for
making and planning the legislative framework for the medical world. The healthcare costs in
Germany are most of the time low but sometimes they can be very high. For example, just like in
the United States, Germany has the same type of problems that we do when it comes to rising

5. 5
Running Head: Germany’s Healthcare system compared with the U.S
costs in medical care. One of the major roles in making the medical treatment so high is the fact
of the aging population (Clark, 2012, Bidgood, 2013). Germany also had a baby boomer stage.
They are seeing a rise in the elderly just the same as we are. These people need a lot of help and
a lot of medical attention which means a lot more in medical costs (Clark, 2012, Bidgood, 2013).
Next, the increasing demand for better medical equipment is another example of why medical
care costs are rising (Clark, 2012, Bidgood, 2013). Doctors and hospitals alike all want better
medical equipment. The more expensive the equipment, the more the patient is going to have to
spend in order for the hospitals to pay for that new equipment. Another reason why medical costs
are so high in Germany are because of the rising costs of medical procedures rising (Clark, 2012,
Bidgood, 2013). With the rise of special procedures like gastric bypass, facial reconstruction, and
Lasik eye surgery are making the costs of healthcare rise. These procedures can rise up to
millions of dollars. The more the people of Germany are getting them the more the cost of
healthcare will rise. Since January 2004 members of the statutory insurance plan have had to pay
€10 per quarter to see a General Practitioner, charges for non-prescription drugs and an end to
free services such as health farm visits and taxi rides to hospital This is not only true in just
Germany, but also in the United States. This is another way that both the United States and
Germany are alike. Because of these high costs, there have been a number of reforms
implemented to help and try to curb the rising costs of healthcare rising (Clark, 2012, Bidgood,
2013). In the past, there have also been budget caps to help stop the rising cost in health care.
These caps were soon phased out because no one really wanted to cut spending on anything.
This next section of the paper will be talking about the quality of care and the
life expectancy of Germany. As of 2012, the life expectancy of Germany is 81 years of age

6. 6
Running Head: Germany’s Healthcare system compared with the U.S
(data.worldbank.org, 2014). The quality of care for Germany has been improving and have been
making bigger strides to even further give the best care for their patients (Clark, 2012, Bidgood,
2013). In the year 2004, the Institute for Quality and Efficiency in Health Care (IQWig) was
created, which provides health technology assessment for drugs and other procedures (Clark,
2012, Bidgood, 2013). All diagnostic and therapeutic procedures applied in ambulatory care
must be positively evaluated in terms of benefits and efficiency before they can be reimbursed by
sickness funds (Clark, 2012, Bidgood, 2013). This means that they are more organized with their
paperwork which means they will have more time to give better quality to the patients. There is a
mandatory quality reporting system for all acute care hospitals in Germany (Clark, 2012,
Bidgood, 2013). This is helping quality of care because by doing a mandatory report it is
allowing both the doctors and patients to see how good or bad the care is that they are getting.
The last way that Germany is improving quality of care is by Hospitals receive individual
feedback based on quality indicators (Clark, 2012, Bidgood, 2013). Since 2007, all hospitals
have been required to publish results on 27 selected indicators of the Federal Office for Quality
Assurance (Clark, 2012, Bidgood, 2013). This help with all hospitals because it allows them to
compare their findings.
In this next section, this paper will be discussing the strengths of Germany’s
healthcare system. First, the German government foots the bill for the unemployed (Khazan,
2014). This means that all medical expenses for children and for those that do not have a job do
not need to pay for any kind of medical need that they might need. For example, if a child went
in for an emergency surgery for their appendix, then all medical costs for that surgery will not
have to be paid for. The same goes for the unemployed. Another strength that Germany’s

7. 7
Running Head: Germany’s Healthcare system compared with the U.S
healthcare system has is there are limitations on out- of- pocket expenses (Khazan, 2014). This
makes it very rare for the German people to go in debt because of medical costs. Most of the out-
of –pocket expenses are paid for by the government. Another strength that Germany has is that
they have no network limitations which means that patients can see a doctor whenever they want
(Khazan, 2014). This can be correlated back to when the paper talked about short waiting times
to see primary care physicians. Another strength for Germany’s healthcare system is that Co-
pays are very small. Each time an adult goes to the doctor or primary care physician, the average
co-pay will pay 10 euros which in U.S dollars is about 12.50 cents. The average Co-pay for the
United States can double that or sometimes triple that. (Khazan, 2014). Next, the payment for
hospital stays are minuscule. The average person can pay only about 40 euros for a 3 three night
stay (Khazan, 2014). In U.S dollar amounts it costs about 50 dollars. This is coming from a
person that was living in Germany that was in the hospital. A final strength that Germany’s
healthcare system has are the Sickness Funds. You can think of these Sickness Funds as being
like the United States’ Medicare and Medicaid. They are both public health insurance. That is
available for anyone that needs it. Sickness Funds are public Health Insurance System covers all
except 13% of wealthy population which can opt out of it (Khazan, 2014). These private health
insurance companies that 13% of the country can get are like our Blue Cross and Blue Shield or
Etna.
This next section of this paper will be discussing some of the weaknesses of
Germany’s healthcare system. First, there are no provider network limitations. Although these
were listed as a strength earlier in the paper, they can also be a negative because doctors don’t
know what other provider patients have seen, so there are few ways to limit repeat procedures

8. 8
Running Head: Germany’s Healthcare system compared with the U.S
(Khazan, 2014). That is like having something like x-rays at one primary care provider and you
switch your doctor and they do the same thing when you just had them done. Another weakness
that Germany’s healthcare system has is a shortage in primary care physicians. For example,
many of them are leaving because they are not getting paid enough, and they are not holding
enough responsibility in the workplace (Khazan, 2014). A final downfall that Germany’s
healthcare system has is the downfall of the Sickness Funds. Although the paper stated earlier
that the Sickness are a good thing which they are, they can get expensive at times. Co-pays can
be brought up to 355 euros a year (Khazan, 2014).
Now this paper is going to take a direction toward looking at the United States
looking at both their strengths and weaknesses and comparing it to the United States. First, these
two systems are very similar. Germany’s healthcare system is like the system that the American
people are living with today with the Affordable Care Act and the Sickness Funds. These
systems are both in their early working and both need to fine tune a few areas of their models.
Some strengths of the U.S Healthcare system include is Employer based insurance. This is good
because flexible and can adjust quickly to changing patterns of accepted medical practice
(Capretta, 2009). The Affordable care Act also covers most of the Americans in the United
States with considering the economy is pretty good. Another strength includes Medicare and
Medicaid and how most people over the age of 65 and people living under the poverty line can
get public health insurance. The American system is also the forefront in the area of clinical
research. A final strength of the American system is that the services that they offer are some of
the best services in the world for people that can afford it.

9. 9
Running Head: Germany’s Healthcare system compared with the U.S
Finally, this paper will talk about some of the weaknesses that the U.S system
has. First, 15% of the population, “37 million people” have no health insurance or coverage (the
highest in the industrialized world) (Cooper, Taylor, 2014). Compared to Germany, this is a very
high number. Another weakness is the cost of healthcare in the U.S is the highest per person in
the industrialized world (Cooper, Taylor, 2014). This high number makes it really hard for
people to actually buy health insurance in the first place. Another weakness that the U.S system
has is that many groups and individual persons are denied healthcare because of pre-existing
conditions (Cooper, Taylor, 2014). All of these conditions can include heart disease, diabetes,
high blood pressure, and obesity. For this reason people that need health insurance the most are
the ones that get denied health insurance the most. A final weakness that the U.S system has is
that they do not have enough primary care physicians (Cooper, Taylor, 2014). This is the same
problem that Germany’s healthcare system gas had. They are just not getting paid enough and
are having responsibility issues in the workplace. This really is a major problem that most
countries are having today.
In conclusion, the paper discussed both Germany’s healthcare system in
coloration to the United States healthcare system. The paper started off talking about how the
German healthcare system came into place. Then talked both about the strengths and the
weaknesses of each system. The paper then Talked about the cost and caring for patients. Finally
the Paper finally talked about The United States and what their strengths and weaknesses were.
The model that was used for both countries was Stones’ Non Rational Model because both
countries are finding problems with their systems and finding ways to fix them.

10. 10
Running Head: Germany’s Healthcare system compared with the U.S
References
Khazan, O. (2014, April 8). What American Healthcare Can Learn From Germany.
Retrieved November 25, 2014, from http://www.theatlantic.com/health/archive/2014/04/what-
american-healthcare-can-learn-from-germany/360133
Clark, E., & Bidgood, E. (2012, 2013). Healthcare Systems: Germany. Retrieved
November 25, 2014, from http://www.civitas.org.uk/nhs/download/germany
Germany. (n.d.). Retrieved November 25, 2014, from http://data.worldbank.org/country/germany
Capretta, J. (2009, January 1). Healthcare in the United States: Strengths, Weaknesses &
the Way Forward | The Center for Bioethics & Human Dignity. Retrieved November 25, 2014,
from https://cbhd.org/content/healthcare-united-states-strengths-weaknesses-way-forward
Cooper, E., & Taylor, L. (2014, January 1). Comparing Health Care Systems. Retrieved
November 25, 2014, from http://www.context.org/iclib/ic39/cooptalr/

11. 11
Running Head: Germany’s Healthcare system compared with the U.S