German healthcare is operated and self-governed by a high number of institutions and organizations. This article explains the participants, organization of health care, and changes overtime. The health care in Germany is offered in two predominant areas: outpatient (primarily within doctors practices) and inpatient (in hospitals). Others are both outpatient and inpatient facilities such as rehabilitation centers. The healthcare system is defined and controlled by numerous institutions and organizations and they have various duties. These are the associations of doctors and hospitals, health insurers, quality assurance agencies, health ministries at federal and state level. And the patient organizations and support groups.
Fundamental principles
In Germany, health care is founded on 4 fundamental principles:
Obligatory insurance
Health insurance is obligatory to every person living in Germany. The vast majority of residents are required to take out public health insurance (gesetzliche Krankenversicherung, or GKV). Also called statutory health insurance. Employees with a gross income above a certain amount (Versicherungspflichtgrenze) have freedom of choice between the public and the private health insurance, except in the case of a company medical plan. This is also possible to other groups of people such as many self-employed people and freelancers, public officials, judges and soldiers.
Insurance premiums
The main way of financing health care in Germany is the regular contributions (premiums) of health care funds members and their employers. It is also supported by the funds of taxpayers. An example of what this entails: health systems such as those in Great Britain or Sweden are almost entirely funded by taxes. In the United States, there is a need to have a private health insurance or shoulder the expenses of treatments and loss of earnings to illness by most people.
Solidarity
All the members of the public health insurance and the members of the employer share the costs by paying monthly premiums. Your premium is calculated in relation to a certain percentage of your income:
The higher the income the higher the payment. However, anyone that earns above a certain level of income (known as the Beitragsbemessungsgrenze) is charged the same maximum premium. There is the possibility to insure some of the family members free of charge, e.g., those who do not have their own income, or do not earn enough. Anyone who falls sick is entitled to the same medical care no matter the level of premium. This implies that the wealthy assist the needy as well as the healthy people assist the sick.
Self-governance
German healthcare system is not government controlled. The government establishes the legal environment of medical care. The further structuring, formation and funding of separate medical services remains largely self-regulated within the health system. This is accomplished through the aid of supporting organizations and care providers such as the public health insurers, doctors and hospitals. In the example of health insurers, the representatives of the insured members and employers decide upon such things as budget issues. Additional services (freiwillige Leistungen) and additional fees (Zusatzbeitraege). Physicians and psychotherapists systematize the nationwide supply of health care in associations of statutory health insurance physicians and dentists (kassenZahnMehrtigungs). The Federal Joint Committee (Gemeinsamer Bundesausschuss or G-BA) is the supreme authority of the self-governing system. This can be found out more about in the section below, in the section about the structure and institutions of the healthcare system.
Institutions, associations and providers
The key health practitioners, facilities and organizations are:
Health insurers
The health insurers have a mandate to offer people in Germany with health insurance and ensure that they obtain medical care. This is achieved by way of contract to a large number of different institutions and organizations, including the associations of statutory health insurance physicians and dentists, to the associations of hospitals and pharmacies.
The National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) is the federal level association of all the public health insurance funds. It is the law-bound activities of the various insurers that it represents. Private health insurers provide their members with full, partial or supplementary cover. They are represented by the association of Private
Health Insurance (PKV-Verband)
Associations of statutory health insurance physicians and dentists: Physicians (doctors), including psychological psychotherapists. Who practice in practices where the cost of the treatment is reimbursed by the statutory health insurers all belong to associations of statutory health insurance physicians at the state level. Which are known as kassen-aerztliche Vereinigungen (KV). Dentists are regulated in associations of statutory health insurance dentists (KassenzahnArztliche Vereinigungen – KZV). The equivalent at the federal level is the Federal Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung – KBV). And the Federal Association of Statutory
Health Insurance Dentists (Kassenzahnärztliche Bundesvereinigung – KZBV)
These associations have a specific range of tasks determined by the law. They should make sure that there are sufficient numbers of doctors’ practices in every location, negotiate the fees with the public health insurers, and review the financial statements and accounts of doctors’ practices.
Hospital federation
The German Hospital Federation (Deutsche Krankenhausgesellschaft -DKG) includes the state and national associations of the owners of hospitals, which include district, city and local governments, churches, non-profit associations and private organizations.
Pharmacy associations
Pharmacies are tasked with the responsibility of providing medication, giving information and advice regarding the same. To ensure that there is sufficient medicine in stock, pharmacy associations enter into contracts with the National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) and statutory health insurers. Pharmacies will be able to provide medication and charge the health insurers.
Other medical careers
These are physical therapists, speech therapists, nurses and midwives. In case they are self employed and provide outpatient care to individuals with public health care insurance, the respective associations conclude agreements with the GKV-Spitzenverband as well.
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