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Universal Health Care Insurance Companies
Legal insurance provided by 109 not-for-profit "illness funds" covering 88% of the population. High-income individuals and civil servants can opt for fully replaceable private insurance, which covers 11% of the population.
Aiming For Truly Universal Health Coverage
Health funds: mandatory wage contributions divided equally between employers and employees and divided into sickness funds using a risk-adjusted cap; Additional income-related contributions paid directly to sickness funds; General tax revenue. Private insurance: individual premium.
Sickness fund participants purchase additional or supplemental policies that cover smaller benefits not covered by SHI, including some co-payments and private hospital rooms.
Covered drugs: 10%, with a minimum of €5.00 ($56.60) and a maximum of €10.00 ($112.21) (or the price of the drug), plus the difference between the price and the reference price.
Hospitalization costs are limited to 28 days per year. Total healthcare costs are limited to 2% of household income; 1% of income for people with chronic diseases.
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Private service providers pay through FFS payments for a maximum number of services each quarter. Generally, gatekeepers and patient registration are not required, but health funds are required to provide the option to register on the Family Physician form with the gate management.
A mixture of public and private not-for-profit organizations, some for-profit. DRG Payments are paid on a case-by-case basis with additional fees for highly specialized and expensive services and techniques (such as chemotherapy).
Health insurance is mandatory in Germany. About 86 percent of the population is enrolled in statutory health insurance, which provides coverage for inpatient, outpatient, mental health, and prescription medications. Management is provided by non-governmental insurance companies known as sickness funds. The government has virtually no role in directly providing health care. Health funds are financed by public wage contributions (14.6%) and a supplementary special purpose contribution (on average 1% of wages), in which both employers and workers participate. Additional fees apply to inpatient services and medications, and sickness funds offer a range of deductible items. Germans who earn more than $68,000 can opt out of SHI and opt for private health insurance. There are no government subsidies for private insurance.
Chancellor Otto von Bismarck's Health Insurance Act of 1883 created the world's first social health insurance system. At first, health insurance was limited to workers. In 1885, 10% of the population was insured and entitled to cash benefits in case of sickness (50% of wages for a maximum of 13 weeks), death or childbirth. Although coverage was limited at first, it gradually expanded. The last step toward universal health coverage occurred in 2007, when health insurance, whether statutory or private, was mandatory for all citizens and permanent residents. Today's scheme provides coverage for the entire population along with a generous benefits package.
Life Vs. Health Insurance: Choosing What To Buy
Health insurance is provided through two sub-systems: statutory health insurance (SHI), which consists of competing, non-governmental, non-profit health insurance plans known as sickness funds; and private health insurance.
Unlike in many other countries, health insurers and private health insurance companies, as well as long-term care insurers, use the same providers. In other words, hospitals and doctors treat all patients regardless of whether they have SHI or private insurance.
The role of government: The German healthcare system is characterized by the division of decision-making powers between the federal and state governments, self-regulatory organizations of payers and providers (see sample).
In the German legal framework, the federal government has extensive regulatory power over health care, but it is not directly involved in the provision of care. The Federal Joint Commission, administered by the Federal Ministry of Health, determines which services must be covered by sickness funds. Coverage decisions are based as far as possible on evidence from comparative effectiveness reviews and health technology (risk-benefit) assessments.
Policies To Achieve Near Universal Health Insurance Coverage
The Federal Joint Commission also sets quality standards for providers and regulates ambulatory care capacity (the number of contract physicians practicing in SHI), using population-to-doctor ratios based on need.
The Federal Joint Committee has 13 voting members: five representatives of health fund associations, five service provider associations and three independent members. The five patient representatives have an advisory role but do not have a vote. However, representatives of patient organizations have the right to participate in the activities of other decision-making bodies, including subcommittees of the Federal Joint Commission.
The Federal Association of HMOs is collaborating with the Federal Union of Statutory Health Insurance Physicians and the German Hospital Association to develop a scale of outpatient care fees for disease funds and a catalog of Diagnostic Related Groups (DRGs), which are then approved by a duo. joint committees. German governments also play an important administrative role. 16 state governments determine hospital capacity and fund their investments. States also oversee public health services.
Regional associations of contracted SHI physicians are required by law to ensure local availability of outpatient services for all specialties in urban and rural areas. These regional associations also negotiate fee schedules for outpatient physicians through the HMOs.
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The role of public health insurance: In 2017, total spending on health was 11.5% of GDP. Of this health spending, 74% of public funds were funded, and most of this spending (57% of the total) went to SHI.
About 88 percent of the population receives primary coverage through health funds and 11 percent through private insurance. In January 2019, there were 109 sick funds.
As of 2019, all working citizens (and other groups such as retirees) earning less than €60,750 (US$77,985) per year are covered compulsorily by SHI.
Individuals whose gross wages exceed the minimum, as well as those who are self-employed and who previously had Social Health Insurance coverage, can choose to remain in the publicly funded system (as 75% do) or purchase alternative private health insurance. Civil servants are exempt from SHI; Their insurance is paid in part by the employer. Military, police, and other public sector employees are covered under small programs separate from SHI. Visitors are not covered by the German SHI. Refugees and undocumented immigrants are covered by social security in case of acute illness and pain, as well as pregnancy and childbirth.
Healthcare Systems And How They Work
Sickness funds are funded by compulsory wage contributions, which are charged as a percentage of total wages up to a cap. Dependents (spouses and non-earning children) are covered free of charge. Since 2016, the law has set a flat tax rate of 14.6 percent of the gross salary, which is divided equally between the employer and employees. As of 2019, earnings over €54,450 ($69,897) per year are tax-deductible.
) and redistribution to individual sickness funds. A risk estimation formula is used, which takes into account age, gender, and morbidity for 80 severe and chronic diseases.
In addition to mandatory salary contributions, an additional income-dependent contribution, which is determined by the fund, is paid directly to health insurance companies.
The role of private health insurance: In 2017, private health insurance accounted for 8.4% of total health spending.
Health Insurance In Germany
This includes replacement coverage purchased by individuals who are exempt from SHI or can withdraw from SHI (such as high-income individuals) as well as supplement policies purchased by sickness fund members.
In June 2018, there were 41 alternative private health insurance companies in Germany, 25 of which were profitable.
Privately insured persons pay risk-related premiums with separate dependent premiums; Risk is only assessed upon entry and contracts are based on lifetime underwriting. Private health insurance is particularly attractive to young people with good incomes, as insurance companies can offer them contracts with a wide range of services and lower premiums.
For those enrolled in a sickness fund, private insurance plays a mixed supplement and supplement role, covering smaller benefits not covered by SHI, including some co-payments (eg for dental care) and private hospital rooms.
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Private health insurance is regulated by the Department of Health and the Federal Financial Supervisory Authority to ensure that policyholders do not experience large increases in premiums as they age and are not burdened with insurance premiums if their income declines. The federal government sets fees for alternative, supplemental, and supplemental private insurance providers through the fee schedule. These fees tend to be higher than the SHI fees. There are no government subsidies for private insurance.
The law defines this broad framework for SHI benefits; However, the details are determined by the Federal Joint Commission.
Sharing costs and personal spending: In 2017, they accounted for 13.5 percent of total health spending, with most individual spending going to nursing homes, and medicines and medical devices.
In order to attract patients, health funds offer a range of discounts and bonuses without claiming compensation. Preventive services do not count toward the deductibles, and there are no fees for recommended preventive services (such as cancer screening at a certain age).
The Army Built To Fight 'medicare For All'
Physicians who have a contract with health insurance companies are not allowed to charge fees beyond the fee schedule for services listed in the Social Health Insurance Benefits Catalog. However, a list of individual health services out of comprehensive coverage may be offered for a fee.
Safety nets: the unemployed contribute to social health insurance in proportion to unemployment claims. The government contributes on their behalf to long-term unemployment. In addition, caps and deductible exemptions (see table above) help reduce the monetary burden on Germans.
Physician education and workforce: O
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