This document discusses the German healthcare system and highlights lessons that can be learned from the Techniker Krankenkasse (TK), a large German statutory health insurer. It provides an overview of healthcare provision and outcomes in Germany compared to the UK. Key characteristics of TK are described, such as its large membership, integrated care contracts, data mining practices, and customer relations management. Finally, weaknesses of the German system and questions for the English NHS are presented.

1. The Techniker Krankenkasse Experience
Lessons from a successful German statutory
health insurer
Naomi Chambers
19 October 2010

2. Summary
• Learning lessons from other healthcare
systems: problems & opportunities
• Healthcare provision in Germany
• Healthcare outcomes in Germany
• Characteristics of TK
• Weaknesses of the system
• Questions for the English & UK NHS

3. Learning lessons
• Path dependency ?
• Country specific cultural contexts ?
• Uncritical adoption of ‘bright ideas’ ?
But…
• Commonality of pressures
• Convergence of policy responses
• Examination of policy options

4. German healthcare system
• Population = 83 million
• Oldest statutory health insurance system
(1883)
• Principles of solidarity and subsidiarity
• Mixture of collective & selective
contracting
• Free choice of providers
• Reduction in numbers of sickness funds
from >1200 (1992) to < 200 (2010)

5. Healthcare provision
(OECD 2008)
Germany UK
% GDP 10.5 8.7
No of physicians 7.8 5.9
(per 1000 population)
No of nurses 10.6 9.5
(ditto)
No of beds 8.2 3.4
(per 100k pop)
Av length stay 7.6 7.1

6. Health status and outcomes
(OECD 2009)
Germany UK
Life expectancy 80.0yrs 79.5yrs
Obesity prevalence 14% 24%
Diabetes prevalence 8.9% 3.6%
Diabetes admissions 14/ 32/100k
Asthma complications 21/ 75/100k

7. Characteristics of TK
• 7.3 million members (10% market)
• 11,000 staff
• Turnover of 17.6 billion euros
• Rated as ‘best’ by German Institute of
Quality in Health Care (IQWiG) & Focus
Money magazine
• Particular strengths: benefits, service &
availability

8. Patient experience of TK
• 24/7 phone service
• Direct access to outpatient specialists
• Some co-payments
• Short or no waiting times for elective care
• Additional benefits package
• Some long waits in GP surgery
• Long waits for psychotherapy
• No continuous medical record

9. TK Integrated care contracts
• Along care pathways across more than
one provider
• Enables intensive treatment eg for back
pain, mental illness, heart conditions
• Results in earlier returns to work thereby
saving on sickness benefit

10. TK data mining
• To discover patterns & relationships in
morbidity, uptake and quality of care
• To predict future demand & regional
differences
• To carry out predictive modelling to select
patients for preventive services ( eg health
coaching)

11. TK customer relations
management
• 24/7 call centre & medical advice line; 8
million contacts per year
• Staff recruited and trained to match
diversity of their insurants
• First contact solution rate = 82%

12. Weaknesses of the system
• Funds have little control over providers
• Some long waits
• Weaknesses in primary care
• Lack of continuous medical record
• Financial risks of over performance
• ‘Unfair’ health fund risk-adjustment system

13. Questions for the NHS
• What is the added (financial, clinical, personal)
value of GP gatekeeping ?
• How much specialist care can we deliver outside
hospital?
• What are the opportunities for a more customer-
oriented approach?
• How can we develop stronger incentives to keep
patients well?
• What are the specific health conditions where
German / others performance is better and are
we learning from their examples?