Krankenversicherung: Healthcare in Germany

In my post Healthcare: International Perspectives, I looked at U.S. healthcare as compared to some other industrialized nations.  Today, I’ll begin my in-depth look at healthcare programs across the world with Germany, since the next overseas trip offered by the IUSB Office of International Programs is to Berlin and Prague next summer.  (The application deadline is January 31, 2014 — it’ll come up faster than you think!  Download the application here.)

In 2008, NPR did a series of programs on healthcare in several different countries, including Germany.  It’s a little old (gosh, when did 2008 get to be so long ago?), but the information is still valid.  The series covered both the facts about healthcare in these nations, and perspectives of individuals using the programs.

While Germany has universal healthcare coverage (meaning all the countries’ citizens are covered), it doesn’t have what’s called a “single-payer system.”  In single-payer systems, healthcare costs are paid entirely by the government with tax money it has collected.  The U.S. and Germany both have multi-payer systems, where money is collected from individuals by multiple entities, often insurance companies, and those entities then pay providers.

Much of the controversy surrounding the ACA (also known as Obamacare) has been around the individual mandate — the requirement that all individuals must carry health insurance or pay a penalty.  The German system also carries an individual mandate; each person and his/her employer pays 8% of their gross income to a “sickness fund” — a nonprofit insurance company.  This sounds like a huge chunk of income, but in reality, the average American who gets health insurance through work pays the same proportion — but usually for inferior coverage.

German ambulance Image credit: Sven Storbeck

German ambulance                                                                                                                      Image credit: Sven Storbeck

German insurance policies have no deductibles, and everyone gets the same level of coverage (whereas in America, different policies cover different things, require different premiums, and have different exemptions, or things for which they won’t pay).  Any and all care for children is completely paid for under Germany’s plan (without premiums), and adults pay very moderate co-pays for doctor and specialist visits (around $15).  Dental coverage is included.  There is private health insurance from for-profit companies available, as well, which costs more and comes with additional benefits (like private hospital rooms and going to the front of the line), but only about 10% of Germans choose to use this plan rather than the non-profit option.

Of course, like any system, it is not without problems.  The American Institute for Contemporary German Studies at Johns Hopkins University lists some of the following issues with the German healthcare system:

  • Lack of a common information-sharing system for medical records.
  • Longer than average waiting periods to see primary care physicians. This does not appear to be a problem with specialists, however.
  • Germany has the 4th highest per-capita spending on healthcare, and their aging population will make cost control in the future difficult.
  • Minor inequity between the privately insured (again, only about 10% of the German population), because costs are higher, and because these plans pay more to providers, so providers tend to favor the privately-insured.

The Commonwealth Fund, a nonpartisan, non-profit organization whose missions is to promote high-performing healthcare systems, provides an excellent summary of German healthcare here.

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