Germany's health system

from Wikipedia, the free encyclopedia

The German health system regulates the relationships in the health system between insurance companies, insured persons, service providers and other groups involved in Germany.

construction

Those involved in the health system in Germany include

With the exception of state hospitals , the services are largely provided privately. Outside of the hospitals, liberal professions such as resident doctors and pharmacists and private companies such as the pharmaceutical and medical technology industries dominate. Hospitals are often still run by non-profit organizations, but are increasingly being privatized. As a service provider, the state only participates in the form of health authorities, communal hospitals or university clinics.

The outpatient and inpatient sectors work almost separately from each other. Critics complain that this leads to inefficient treatment.

financing

The largest part of the German population is insured in the statutory health insurance (GKV), the contributions of which are mainly based on the income of the insured , up to the assessment ceiling of the health insurance. Family members are also insured free of charge under certain conditions. The entitlement to benefits is independent of the amount of the contributions paid. Around 10.5% of the population have private health insurance . Here the premiums are based on the agreed scope of services, the general state of health and the entry age. 2.3% of the population are covered by other means (e.g. members of the armed forces, social service providers, welfare recipients). Only about 0.1% to 0.3% are without health insurance coverage. With a few exceptions, the health insurance contributions were paid equally by employees and employers until June 30, 2005. From July 1, 2005, the employee's contribution rate was 0.9 percentage points higher than that of the employer due to the so-called "special contribution". From January 1, 2019, all costs will again be financed equally.

After insurance benefits, patient co-payments or deductibles make up a growing proportion of the financing of the health system. In some areas, subsidies or co-payments are provided by the state or by non-profit organizations. In addition, outside of insurance benefits, a significant health market has developed for “ individual health benefits ” (IGeL), fitness , wellness , anti-aging , cosmetic surgery , cosmetics , non-reimbursable drugs , alternative healing methods and esoteric practices .

statistical data

In a comparison of health expenditure in the OECD countries, Germany was in fourth place in 2006 with a share of 10.6% of GDP . This makes the German health system one of the most expensive in the world. The public sector bore 77% of these costs (OECD average: 73%). The density of personnel in Germany is also above average. In 2014 there were 4.13 doctors per 1000 inhabitants and in 2006 9.8 nurses, compared with (2006) 3.1 doctors and 9.7 nurses in the OECD average.

In 2007, 4.4 million people worked in the healthcare industry. That was around 10% of all employees in Germany. In 2008 there were 76,000 more employees than in the previous year.

Hospitals:

  • Medical staff in the clinics (2007): 136,000
  • Nursing staff: 498,000
  • Non-medical staff in the clinics: 194,000
  • Total hospital staff: 1.075 million employees
  • Total turnover of hospitals (2005): € 62.1 billion per year
  • Number of hospital beds in 2007: 506,954 (in 2087 clinics).
  • Cases treated in hospitals: 17.2 million
  • Average length of stay in hospital: 8.3 days
  • The number of hospital beds and the length of stay have been decreasing continuously since 1991.

Outpatient:

  • General practitioners and specialists in private practice in 2007: 138,000
  • Non-medical staff in doctor's offices: 307,000
  • Number of pharmacies in 2004: 21,392
  • Employees in pharmacies: approx. 173,000

Development of life expectancy

According to the World Bank , the average life expectancy at birth in 2015 increased from 69.3 years in 1960 to 81.1 years. In the ranking of countries according to life expectancy, Germany ranks 29th worldwide. Figures apply from 1960 to 1985 for the average for the two German states and from 1990 for the reunified Germany.

year Life expectancy
in years 		year Life expectancy in
years
1960 69.3 1990 75.2
1965 70.2 1995 76.4
1970 70.6 2000 77.9
1975 71.4 2005 78.9
1980 72.7 2010 80.0
1985 74.1 2015 81.1

Medical expenses

Distribution of statutory health insurance expenditure in 2006:
Cost type Shares
Hospital treatment 34.0%
drug 17.5%
Medical treatment 15.1%
administrative expenses 5.5%
Dental treatment 5.2%
Sick pay 3.9%
Tools 3.1%
Remedies 2.5%
ride costs 2.0%
Prevention and rehabilitation measures 1.6%
Home care 1.4%
Other expenses 6.4%
The highest expenses were accounted for
Diseases of Expenditure in billions of euros
Cardiovascular system 35.5
Digestive system around 31
Musculoskeletal system approx. 25
Mental illness almost 22

The cost of illness includes all health expenses that are directly connected to medical treatment, but not investments in the health care system. The total expenditure in 2006 was 234 billion euros, which is around 2,700 euros per person (women 3,160 euros, men 2,240 euros). For the treatment, rehabilitation or care of people over 65 years of age (approx. 17% of the population), 111 billion euros were spent in 2006, 47% of all medical costs. That is 6,910 euros per capita compared to 1,880 euros for the younger generation.

According to other information, medical costs in Germany totaled around 236 billion euros in 2006. Almost half of these costs (47 percent) were incurred by people aged 65 and over. This is shown by the results of the medical expenses calculation by the Federal Statistical Office. This calculation estimates the macroeconomic consequences of diseases. This includes (with the exception of the investments in the health care system) all health expenditure that is directly connected to medical treatment, prevention, rehabilitation or care measures. The highest costs of 24.6 billion euros were due to cardiovascular diseases in old age . Musculoskeletal disorders (13.1 billion euros), psychological and behavioral disorders (12.7 billion euros) and digestive system diseases (9.8 billion euros) follow at a distance . Average annual medical costs per inhabitant in euros: 85 years and older: men 11,490 euros, women 15,330 euros; 65 to under 85 years: men 6,000 euros, women 6,170 euros; 45 to under 65 years: men 2,800 euros, women 3,050 euros, 30 to under 45 years: men 320 euros, women 910 euros; 15 to under 30 years: men 930 euros, women 1,460 euros; under 15 years: boys 1,370 euros, girls 1,140 euros; all age groups: men 2,480 euros, women 3,230 euros.

Medical expenses are divided into a direct and an indirect component. The direct share adds up the resource consumption that is directly related to the treatment of the disease under consideration. The direct costs include B. drug costs, medical costs, laboratory costs, costs for hospital stays. In addition to the direct macroeconomic effects, there are also indirect costs, as the ability to work is partially or completely reduced. The indirect illness costs can significantly exceed the direct costs. In Germany, transfer payments such as pensions and social assistance are not counted as indirect costs, but are shown separately.

There are also intangible costs, such as a loss of quality of life. These costs are difficult to quantify.

At the beginning of September 2013, 59 out of 134 health insurers were criticized . They are under suspicion of manipulation because they are said to have reported the illnesses of their members incorrectly in order to receive more money due to the increased sickness rate. The Federal Insurance Office is investigating the suspicion.

In 2012, for example, Germany's hospitals had to reimburse the health insurance companies for 1.7 billion euros due to incorrect bills, according to an evaluation by the umbrella association of statutory health insurance companies ( GKV-Spitzenverband ).

A later survey by the National Association of Statutory Health Insurance Funds showed that Germany's hospitals had to repay a total of 2.8 billion euros to the health insurers in 2017 due to incorrect invoices. More than every second invoice checked (more than 56 percent) was incorrect.

Corruption in Health Care

In public, the German health care system is repeatedly associated with corruption , which causes damage in the billions. According to the findings of the Federal Criminal Police Office , public officials in health authorities are among those most severely affected by corruption. For example, in 2004 a pharmaceutical company “donated donations to doctors and hospital staff throughout Germany”. Transparency International estimates the annual damage caused to the German health system by fraud, waste and corruption at around 6% of the total budget. The National Association of Statutory Health Insurance Physicians and the Federal Association of the Pharmaceutical Industry criticize this estimate as grossly incorrect, as data from the USA would be transferred to Germany.

The Federal Court of Justice denied a corruption allegation in 2012, since doctors in private practice are freelance service providers and not public officials - i.e. not employees of authorities or companies that are subject to tendering. This criminal liability loophole was largely closed by the legislature in 2016 with the law to combat corruption in the healthcare sector .

See also

literature

  • Health in Germany , federal health reporting based on health monitoring by the Robert Koch Institute, Berlin, 2015.
  • Fritz Beske, Hermann Bechtel, Johannes F. Hallauer: The health system in Germany , Deutscher Ärzte-Verlag, Cologne 2004.
  • Daniel Biedermann et al .: Health insurance and healthcare - what next? Hans Huber publishing house, Bern 1999.
  • Hans-Ulrich Deppe : To the social anatomy of the health system. Neoliberalism and Health Policy in Germany , VAS Verlag, 2nd edition 2002.
  • Leonhart pocket yearbook health care 2004/2005 - institutions, associations, contact persons. Germany - Federation and Länder , KM Leonhart Verlag Munich, 5th edition 2004. ISBN 3-9806190-9-5
  • Hartmut Reiners: Sick and broke. The German Health System , Suhrkamp Verlag, Berlin 2011, ISBN 978-3-518-46247-8
  • Michael Simon, The Health System in Germany. An introduction to structure and functionality , Verlag Hans Huber, Bern, Göttingen u. a. 2005.

Web links

Individual evidence

  1. ^ Rita Baur, Andreas Heimer, Silvia Wieseler: "Health systems and reform approaches in international comparison", in: Jan Böcken, Martin Butzlaff, Andreas Esche (eds.): Reforms in the health system. Results of the international research , Bertelsmann-Stiftung publishing house, Gütersloh, 3rd edition 2001. ISBN 3-89204-515-1 .
  2. ^ Association of Private Health Insurance V.
  3. ↑ Bundestag resolves parity - 50:50 financing in health insurance. Retrieved on February 24, 2019 (German).
  4. ↑ OECD Health Data 2008 , December 10, 2008.
  5. ↑ "Employment in the health care system continues to rise" ( Memento of the original from December 20, 2008 in the Internet Archive ) Info: The archive link was inserted automatically and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. , Federal Statistical Office (Destatis), press release no.490, December 17, 2008.  @1@ 2Template: Webachiv / IABot / www.destatis.de
  6. ↑ Deutsches Ärzteblatt, March 26, 2010, p. A 522
  7. ↑ a b c d e f g "Health - Personnel"  ( page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice. , Federal Statistical Office (Destatis), December 17, 2008.@1@ 2Template: Toter Link / www-ec.destatis.de  
  8. ↑ Datenreport 2008, Chapter 9: "Health and Social Security" ( Memento of the original from December 29, 2009 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. , Federal Statistical Office (Destatis), October 2008. @1@ 2Template: Webachiv / IABot / www.destatis.de
  9. ↑ a b c d Federal Statistical Office, Hospitals - Facilities, Beds and Patient Movement ( Memento of the original from October 22, 2008 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. , accessed January 5, 2009.  @1@ 2Template: Webachiv / IABot / www.destatis.de
  10. ^ "Health in Germany" , Federal Health Reporting, July 2006.
  11. ↑ Life expectancy at birth, total (years) | Data. Retrieved January 6, 2018 (American English).
  12. ↑ Focus No. 30/2007, July 23, 2007, p. 21
  13. ↑ Information from the Federal Statistical Office, 2006.
  14. ↑ What illness costs. Deutsches Ärzteblatt, September 19, 2008, p. 102
  15. ↑ Health insurance companies under suspicion: Office rebukes funds for incorrect health data ( memento of the original from September 5, 2013 in the Internet Archive ) Info: The archive link was inserted automatically and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. , last accessed on September 6, 2013. @1@ 2Template: Webachiv / IABot / www.finanzen.de
  16. ↑ NOZ: Every second hospital bill that is checked is incorrect. Retrieved May 2, 2019 .
  17. ↑ NOZ: Every second hospital bill that is checked is incorrect. Retrieved May 2, 2019 .
  18. ↑  ( page no longer available , search in web archives ) sueddeutsche.de@1@ 2Template: Toter Link / www.sueddeutsche.de
  19. ↑ Second periodic safety report 2006 ( Memento of the original from January 17, 2012 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. , P. 252, Federal Criminal Police Office. @1@ 2Template: Webachiv / IABot / www.bka.de
  20. ↑ First periodic safety report 2001 ( Memento of the original from September 16, 2009 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. , P. 165, Federal Criminal Police Office. @1@ 2Template: Webachiv / IABot / www.bka.de
  21. ↑ Second periodic safety report 2006 ( Memento of the original from March 3, 2012 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (PDF; 12.7 MB), p. 252, footnote 135, Federal Criminal Police Office. @1@ 2Template: Webachiv / IABot / www.bka.de
  22. ↑ Eliminate mismanagement: Fee increases are no solution ( memento of the original from September 12, 2010 in the Internet Archive ) Info: The archive link was automatically inserted and not yet checked. Please check the original and archive link according to the instructions and then remove this notice. , Press release, May 16, 2006, Transparency International.  @1@ 2Template: Webachiv / IABot / www.transparency.de
  23. ↑ Corruption: Billions in damage to the health system. In: Spiegel Online . November 12, 2004, accessed June 9, 2018 .
  24. ^ BGH decision of March 29, 2012, Az. GSSt 2/11.