The german health care system

The German health care system is supported and self-governed by many institutions and actors. We provide information on which organizations play a role, how the care system is structured and how it has developed.

The care system in Germany is divided into three areas: There is outpatient care, the hospital sector, and outpatient and inpatient rehabilitation facilities.

The actors in the health care system include associations and interest groups representing the various providers and professional groups, health insurance companies, quality arance institutions, the Ministry of Health, and patient organizations and self-help groups.

Basic principles of the supply system Information about $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

The system of health care in Germany is based on four basic principles:

Compulsory insurance: All citizens are obliged to be insured in a statutory health insurance fund (GKV) – as long as they do not earn more than a certain gross amount ("compulsory insurance limit"). Those who earn more, can insure themselves in a private health insurance (PKV).

Contribution financing: Health care is predominantly financed by contributions from citizens with health insurance and employers. Subsidies from tax revenues are added. By comparison, state-run health care systems, such as those in Great Britain or Sweden, operate with tax revenues. In market-oriented systems such as the USA, many citizens have to pay for treatment costs themselves. to pay for loss of earnings due to illness or to insure privately.

Solidarity principle: In the "solidarity community" of the health care system, all those insured by law jointly bear the personal risk of the costs incurred by an illness. Every legally insured person has the same entitlement to medical care and continued payment of wages during an illness – no matter how high his income and thus his contributions are. The amount of the contribution is based on income. In this way, rich people stand up for poor people, but also healthy people stand up for sick people. However, contributions are only calculated on a percentage basis up to a certain income level (the "contribution assessment ceiling"). Everyone who earns more pays the same maximum amount.

Self-governance principle: Although the state decides the framework conditions for medical care. However, the further organization and financing of the individual medical services is the task of the so-called self-administration in the health care system. It is jointly managed by representatives of physicians and dentists, psychotherapists, hospitals, health insurers and insured persons. The supreme body of self-government within the framework of statutory health insurance is the Federal Joint Committee ( G-BA , see below "Structure and actors of the health care system").

Some history: the five branches of social insurance information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

The foundations of the German health system date back to the Middle Ages. At that time, for example, craftsmen were organized into so-called guilds. In them, there were already preliminary forms of the solidary health insurance: All members of a guild paid contributions into a common fund. From this, individual members could be supported if they were in need, for example, because of an illness. Since the beginning of industrialization, there have been factory workers' health insurance funds, for example. The various forms of social security were standardized by social policy at the end of the 19th century. The social legislation of the late nineteenth century, the so-called Bismarckian social legislation. The first to introduce health insurance was in 1883. Initially, it was primarily intended to cover workers in industry, the skilled trades and small businesses when they fell ill.

All insured persons received a legal right to free medical treatment and medicines, as well as sickness and death benefits. At that time, about 10 percent of the population had health insurance – today it is almost 100 percent.

The introduction of health insurance in 1883 was followed by statutory accident insurance (1884) and pension insurance (1889). Unemployment insurance for blue- and white-collar workers was introduced in 1927.

Accident insurance provides, among other things, medical benefits in the event of work-related accidents and occupational diseases, as well as cash benefits in the event of work-related disability and death. Accident insurance is also a compulsory insurance, but is financed solely by employer contributions.

The statutory pension insurance is financed in equal parts by contributions from employees and employers. It pays old-age pensions, disability pensions as well as rehabilitation benefits for employed persons.

It was not until 1995 that the fifth branch of the social insurance system was introduced: long-term care insurance. It ames a share of the costs for care and nursing if someone becomes in need of care.

The legal requirements for the five branches of social insurance are found in the social security codes.

Structure and actors of the health care system Information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

At the federal level, the Federal Ministry of Health (BMG) shapes health policy. Among other things, it prepares laws and draws up administrative regulations for the activities of self-government in the health sector. The BMG is also responsible for a number of institutions and authorities that deal with higher-level health ies . These include, for example, the Federal Institute for Drugs and Medical Devices (BfArM) and the Paul Ehrlich Institute (PEI). The BfArM is responsible, among other things, for the approval of drugs. The tasks of the PEI include, for example, the approval of vaccines.

In the context of statutory health insurance, the

Joint Federal Committee ( G-BA ) the supreme decision-making body of the joint self-administration in the health care system. It consists of representatives of physicians, dentists and psychotherapists, statutory health insurers, hospitals and patients. As the central body of self-government at the federal level, the G-BA decides, among other things, which medical services the statutory health insurance funds will pay for and in what form they will be provided.

In addition, the G-BA is responsible for quality arance measures in health care. The G-BA is supported in its work by the Institute for Quality and Efficiency in Health Care (IQWiG), the publisher of this website. The Institute evaluates the benefits and risks of treatment and examination methods. Experts then evaluate the knowledge on selected topics. The results are to be incorporated into future decisions on health care provision. On the IQWiG platform " ThemenCheck Medizin ", citizens can ask research questions.

Major health care providers, facilities, and associations are:

Health insurance companies: The statutory health insurance funds have the duty to insure citizens and ensure that they receive medical services. To this end, they conclude contracts with a wide range of institutions and organizations, u.a. The associations of SHI-accredited physicians and dentists as well as associations of physicians, hospitals and pharmacists. The association of all statutory health insurance funds at the federal level is called "GKV-Spitzenverband" . It ames legally defined tasks. Represents the interests of the various health insurance funds. Private health insurers offer their customers either full, partial or supplementary insurance policies. Their representative body is the " PKV-Verband ".

Associations of panel doctors and dentists: All physicians and psychological psychotherapists who bill the statutory health insurance are organized in the federal states in Kassenarztliche Vereinigungen (KV), dentists in Kassenzahnarztliche Vereinigungen (KZV). The responsible associations at the federal level are the Kassenarztliche Bundesvereinigung (KBV) (National Association of Statutory Health Insurance Physicians). The National Association of Statutory Health Insurance Dentists (KZBV). The responsibilities of associations are defined by law.

Hospital association: The German Hospital Association (DKG) represents top and state associations of the various hospital operators, such as cities and municipalities, churches, non-profit associations and other private operators.

the Chambers of Physicians, Dentists, Psychotherapists and Pharmacists: At the state level, all physicians, dentists, psychotherapists and pharmacists are compulsory members of their relevant state chamber. The tasks of the chambers include monitoring professional duties and compliance with the X-ray and radiation ordinances. They are responsible for professional recognition, specialist examinations and the assessment and arbitration of allegations of treatment errors. The state chambers have formed corresponding federal chambers at the federal level.

Public Health Service (oGD): The task of the oGD is to protect the population from health hazards. The municipal health offices, in particular, take care of hygiene in community facilities, infection control and general health promotion, for example. They also provide advice. Help with psychosocial problems, for example.

Pharmacists' associations: Pharmacies are responsible for dispensing drugs to consumers. Pharmacists also have the task of providing information and advice on medicines. In order to ensure the provision of care, their associations must conclude contracts with the GKV-Spitzenverband and the health insurance companies.

Non-physician health care professionals: Last but not least, there are many so-called non-medical health care professions. These include, for example, physiotherapists, speech therapists, nurses and midwives. Insofar as they offer health insurance services, their associations also conclude contracts with the GKV-Spitzenverband and the health insurance funds.

Patient organizations and self-help: Many people have joined together to form self-help groups and patient organizations that advise and support patients. Various patient organizations also represent the interests of patients in health policy ies.

Outpatient care Information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

Outpatient care in Germany is mainly provided by self-employed physicians in private practice, dentists, psychotherapists and specialists from non-medical professions. Most physicians and dentists are licensed by the health insurers, i.e. they treat patients with statutory health insurance.

Most people go to their family doctor first if they are ill or have a health problem. General practitioners, general physicians, internists or pediatricians and adolescents are considered family doctors. In the case of special medical problems, they refer the patient to an appropriate specialist practice, for example, for gynecology or for skin diseases (dermatology). However, it is also possible to go directly to a special medical specialist.

In addition to their membership in the respective Association of Statutory Health Insurance Physicians or Association of Statutory Health Insurance Dentists, general practitioners, specialists and dentists each have their own associations that represent their specific professional interests.

In addition to individual practices, there are many group practices or medical care centers in Germany in which two or more physicians and specialists from non-medical professions work together. Such large practices can often offer services that are otherwise only available in hospitals, such as special examinations or outpatient surgery. They are therefore sometimes referred to as "practice clinics".

Outpatient care also includes outpatient treatment in hospitals or psychiatric facilities.

Inpatient care Information on $CMS_IF( ! tt_headline.isEmpty)$$CMS_VALUE(tt_headline.toText(false).convert2)$$CMS_END_IF$

Most hospitals in Germany treat patients with statutory and private health insurance. The large hospitals usually have public sponsors, i.e., states and municipalities. Non-profit or denominational hospitals are run by charitable organizations such as the Red Cross or by churches. In addition, there are many clinics run by private companies. Some of them only accept private patients. They usually have comparatively few beds, and many specialize in particular fields of medicine.

If a longer hospital stay is necessary, one speaks of "inpatient treatment". Even those with statutory health insurance must make an additional payment for accommodation and meals. This is recorded in the "hospital contract" between the patient and the clinic prior to treatment.

In addition to inpatient hospital care, there is also the area of inpatient medical rehabilitation. Rehabilitation facilities provide treatment to help people become independent and able to function again after a serious illness and intensive therapy. Physiotherapeutic treatments, psychological care and support in the use of aids are offered, among other things. Often follows a stay in a hospital, for example, after surgery . Last but not least, there are rehabilitation facilities for mental and addictive disorders.

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