Health system

from Wikipedia, the free encyclopedia

The health care system or health care to all persons, organizations, institutions, rules and processes, whose task is to promote and preserve the health and their safety through prevention and treatment of diseases and injuries is. The term health care is used to describe the extremely complex health care system for patient care and health maintenance, whereas the health industry as a whole, in addition to the inpatient and outpatient care of the sick and the prevention of illnesses in healthy people, also includes the manufacture of drugs and medical products , health tourism , wellness - as well as the fitness industry .

Green: countries with universal health care

In Austria, the term medical services is also used for this, but this term is otherwise used specifically for emergency medical services and first aid, the military sector, disaster / civil protection, and various public tasks such as hygiene.


The following goals for a health care system can be found in the scientific literature:

In 2000, the World Health Organization ( WHO) set goals by which it measures national health systems:

  • responding to the needs of the population in more general issues such as dignity, self-determination, data protection and customer orientation ,
  • the fair distribution of financial burdens as well
  • the health level of the population.

In 2001 the EU Commission also defined goals for health care and care for the elderly:

  • long-term financial viability,
  • high quality and
  • Access for everyone.

The question of financing is linked to the question of which patients receive which treatment and how quickly. In the doctor's surgeries, saving - especially in the case of general practitioners at the end of a quarter, when the “points” of the practice are used up - has long since led to secret rationing . Sweden practices a system that incorporates cost-benefit considerations into medical decisions.


Those involved in a health system are

Financing models

A characteristic feature of a health system is the way it is financed. There are basically three classes:

  • National Health Service : Funding from tax revenues (e.g. Great Britain, Italy, Ireland, Denmark, Portugal)
  • Private insurance model: Financing through voluntary health insurance (e.g. USA)
  • Social insurance model: Financing through compulsory statutory insurance (e.g. Germany, France, Benelux).

There is also the Dutch model, consisting of a health premium and an income-related contribution.

International comparisons

Health expenditure

Increase in health system costs between 1970 and 2007 in various countries (in USD / head of population, source: OECD)

The table on the right shows the countries with the highest relative expenditure on healthcare as a share of gross domestic product and the countries with the highest absolute expenditure as US dollars per capita adjusted for purchasing power in 2008.

On average for the OECD member countries, health expenditure is growing faster than economic power. The per capita expenditure increased by over 80% from 1990 to 2005, while the gross domestic product (GDP) per capita grew by only 37%. In 1970, health expenditure was still 5% of GDP on average, but in 1990 it had risen to 7% and rose to 9% by 2005. In Germany, health expenditure in 2010 was EUR 287.3 billion, which corresponds to 11.6% of GDP.

Health expenditure
country Share of
gross domestic product
in 2013

US dollars
per capita adjusted for purchasing power
United States 16.4% 8,713
Switzerland 11.1% 6.325
France 10.9% 4.124
Germany 11% 4,819
Belgium 10.2% 4,256
Austria 10.1% 4,553
Canada 10.2% 4,351
Denmark 9.7% 4,553
Netherlands 11.1% 5.131
New Zealand 9.5% 3,328
Sweden 11% 4,904
OECD average 8.9% 3,453
WHO ranking of health systems according to "Attainment of Goals" (fulfillment of WHO criteria)
rank country rank country
1 Japan 11 Italy
2 Switzerland 12 Australia
3 Norway 13 Belgium
4th Sweden 14th Germany
5 Luxembourg 15th United States
6th France 16 Iceland
7th Canada 17th Cuba
8th Netherlands 18th Poland
9 Great Britain 132 China
10 Austria 191 Sierra Leone
WHO ranking of health systems by performance *
rank country rank country
1 France 16 Luxembourg
2 Italy 17th Netherlands
3 San Marino 18th Great Britain
4th Andorra 20th Switzerland
5 Malta 25th Germany
6th Singapore 37 United States
7th Spain 39 Cuba
8th Oman 50 Poland
9 Austria 144 China
10 Japan 191 Sierra Leone

* Fulfillment of the WHO criteria compared to the resources used


Assessing the quality of health systems is difficult. For example, a high proportion of sick people in the population does not necessarily indicate poor medical care. On the contrary, a diabetic in a country with poor medical care will soon die and thus fall out of the health statistics. In a country with good medical care, however, he can live on for a long time, but is listed in the statistics as a sick person. However, a high proportion of sick people in the population is an indication that medical care is more concerned with treating symptoms than eliminating the causes. For example, the diabetic receives insulin in order to be able to continue living with his illness, but the specific causes of the dysfunction are not identified and, if necessary, eliminated. The situation is similar for a number of other illnesses, mainly caused by diet and lifestyle, which are responsible for a large proportion of care cases.

The World Health Organization has ranked the health systems of its 191 member countries. A comparison was made on the basis of the above-mentioned goals - health level, needs orientation and financial equity - on the basis of data from 1997. The study resulted in the following positions in the table above.

According to an international study conducted by the University of Washington, health improved in 167 of 195 countries from 1990 to 2015. Andorra received the best rating for access and quality of health care in 2015, followed by Iceland and Switzerland; Austria came in 13th and Germany in 20th place.

In the Deutsches Ärzteblatt , however, the study is accused of having a too small and dubious database and political coloring. It also criticizes the fact that the rankings in the individual categories of the study differ greatly.

The international patient safety goals serve the worldwide quality assurance in medicine .

See also


  • Alexander Dietz: Just health reform? Allocation of resources in medicine from an ethical perspective . Campus-Verlag, Frankfurt am Main 2011, ISBN 978-3-593-39511-1
  • 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 . 3. Edition. Bertelsmann Foundation publishing house , Gütersloh 2001, ISBN 3-89204-515-1 .
  • Fritz Beske, Thomas Drabinski, Herbert Zöllner: The health system in international comparison - an answer to the criticism. Schmidt & Klaunig, Kiel 2004, ISBN 3-88312-290-4 .
  • Fritz Beske, Thomas Drabinski: The health care service catalog in international comparison. An analysis of 14 countries. Schmidt & Klaunig, Kiel 2005. Vol. I: Structure, financing and health services. ISBN 3-88312-330-7 . Bd: II: Cash benefits. ISBN 3-88312-331-5 .
  • Dartmouth Medical School. Center for the Evaluative Clinical Sciences: Dartmouth Atlas of Health Care. Regional Differences in Costs and Care. 2007, ISBN 1-55648-171-3 . ( Homepage ).
  • Fritz Dross, Wolfgang Woelk et al .: Health, public. In: Werner E. Gerabek , Bernhard D. Haage, Gundolf Keil , Wolfgang Wegner (eds.): Enzyklopädie Medizingeschichte. Walter de Gruyter, Berlin and New York 2005, ISBN 3-11-015714-4 , pp. 487-492.
  • Wolfgang Uwe Eckart, Robert Jütte: The European health system: Similarities and differences in historical perspective. UTB , Stuttgart 2007, ISBN 978-3-8252-2903-0 .
  • Kurt Fleischhauer: Raising and distributing funds for the health service. Regulations and problems in Germany, Great Britain and the USA. Alber, Freiburg 2007 (DRZE assessment reports, vol. 6).
  • Maria M. Hofmarcher: The Austrian health system. Actors, data, analyzes. Medical Scientific Publishing Company, Berlin 2013. ISBN 978-3-95466-052-0 .
  • Rolf Rosenbrock , Thomas Gerlinger: Health Policy. A systematic introduction. 2nd Edition. Hans Huber, Bern 2006, ISBN 3-456-84225-2 .

Web links

Commons : health care systems  - collection of images, videos, and audio files
Wiktionary: Health system  - explanations of meanings, word origins, synonyms, translations

Individual evidence

  1. AJW Goldschmidt, J. Hilbert: From the burden to the chance - the paradigm shift from the health system to the health economy . In: AJW Goldschmidt, J. Hilbert (Hrsg.): Health economy in Germany. The future industry . Volume 1 of the series of publications: Health Economics and Management. kma-Reader - The library for managers . Wikom-Verlag (Thieme), Wegscheid 2009, ISBN 978-3-9812646-0-9 , pp. 20-40.
  2. a b Willy Oggier: Page no longer available , search in web archives: advantages of a single fund. (PDF; 473 kB) Final report on behalf of the Federal Social Insurance Office, 2001.@1@ 2Template: Dead Link /
  3. Markus Grabka: Alternative financing models of a social health insurance in Germany - methodological basis and exemplary implementation of a microsimulation study. Dissertation, TU Berlin, 2004, p. 60.
  4. a b WHO World Health Report 2000 (English)
  5. EU press release IP / 01/1747 of December 5, 2001.
  6. Harro Abrecht: Health Care: Medicine at the Limit . In: Die Zeit , No. 51/2009.
  7. Martin Spiewak: Health care: Haggling over the prescription . In: Die Zeit , No. 51/2009.
  8. Harro Albrecht: Health Care: Freshly Weighted . In: Die Zeit , No. 51/2009.
  9. German Doctors' Day Resolution V 58 of the 113th German Doctors' Day 2010 in Dresden: "The German Doctors' Day should once again decide that the medical profession no longer uses the word" service provider ". The term is incompatible with the dignity of the medical art of healing of doctors in clinics and practices. The vocabulary is used by interested parties to promote the deprofessionalization of the medical profession ” .
  10. ^ Health care reform: Learning from the Dutch. In: Spiegel Online . March 29, 2006, accessed December 27, 2014 .
  11. OECD health data 2010 .
  12. Current figure for Germany from the Federal Statistical Office ( Memento of the original from November 14, 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. @1@ 2Template: Webachiv / IABot /
  13. see also: Norwegian National Public Health Agency
  14. ^ Peter Schauder: Nutritional Medicine . Elsevier, 2006.
  15. ^ HK Biesalski: Nutritional medicine . Thieme, 2010, ISBN 978-3-13-154384-4 .
  16. Global comparison: Germany's health system ranks 20th. In: Spiegel Online . May 19, 2017. Retrieved May 19, 2017 .
  17. Hans-Joachim Maes: Deutsches Ärzteblatt: "World Health Report": Mixture of hard and soft data . In: Deutsches Ärzteblatt . tape 97 , no. 36 . Deutscher Ärzte-Verlag , September 8, 2000, p. A-2289 / B-1953 / C-1837 .