The German healthcare system has been considered as among the top best in the world, paving the way for modern healthcare delivery systems. The system was first introduced in 1883 by Otto von Bismarck, making Germany the first country in the world to adopt the health care insurance system (Busse, Blümel, Knieps, & Barnighausen, 2017). With over 100 years of continuous development, the German healthcare system has evolved to become the envy for many countries, including other similarly developed countries like the United States.
On the other hand, the American healthcare system is still trying to establish itself. Modern healthcare systems in the United States have not had a century to develop when compared to the German operations. They were recently implemented not long ago, probably just a few decades ago. This places the United States in a delicate situation since any wrong moves at this point will have severe repercussions. However, the American system is relatively sustainable compared to other countries. The paper is aimed at comparing the German and American health systems. The German healthcare system has had years to develop, thus has the potential to accrue more benefits when compared to the recently established American healthcare system. However, the American healthcare system has time and time proven to be resilient thus can be said to be sustainable. However, is this all true? A comparison of the two healthcare systems is to answer that question. Several healthcare concepts will be contrasted and an informed conclusion drawn from the findings.
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Comparisons
Both countries have insurance coverage aimed at paying the medical bills for the patients. The German health insurance system was first introduced in 1883. The policy states that all people should contribute a proportion of their income towards self-health benefits. The insurance system integrates a communist approach in that the high-income earners support the economically disadvantaged. This further translates to the young subsidizing costs for the elderly and the healthy helping the sick ones (Mossialos, Wenzi, Osborn, & Sarnak, 2016). This can be viewed as a self-sustaining healthcare system.
Initially, the German health Insurance was limited to middle-level workers accounting for only 10 % of the population. However, the state made it compulsory for all citizens to get insurance, which increased the number of individuals covered by the program. The healthcare system is divided into three main sectors which include the outpatient, inpatient care and rehabilitation facilities. Four principles guide the overall system; they include compulsory insurance which requires all citizens to have insurance, funding through insurance premiums, the principle of solidarity which dictates all people have an equal right to medical care and finally, the principle of self-governance.
Most of the German health insurance is publicly financed, accounting for around 74% in 2014. Despite this, 8.8 million Germans are still covered by private health insurance since it offers a broader array of services as compared to the statutory policy. The health insurance in Germany covers all medical services, including prescription drugs other than those excluded by law such as lifestyle drugs.
On the other hand, Scott (2016) suggests that the American health care system provokes much mass opinion with a thick line separating the two views, all based on insurance coverage. Covered individuals consider it the best, while uninsured deem it the worst. Initially, the United States traditionally involved an individual buying their health insurance. Privileged individuals had access to better doctors and top-notch hospitals, thereby translating to better health care services as compared to those who could not afford. However, jobs that covered health insurance remained the go-to option for the average citizen, accounting for up to 156 million citizens. The health situation in the United States changed in 2010 when the Affordable Care Act was passed, and it entailed a multisectoral approach to the health care issue.
The Affordable Care Act was an American approach to achieving universal healthcare for all its citizens. The act stipulated that healthcare responsibilities be to be shared among the government, employers and the individual, which served to boost health care coverage. Generally, the American health insurance covers only ten services that are deemed essential by the state. The facilities include hospitalization, ambulatory services, emergency services, mental health, and substance abuse services, maternity and newborn care services, prescription drugs, rehabilitative services, laboratory services, preventive and chronic disease management, and pediatric services. However, each state is responsible for determining the extent of the services covered, hence creating room for service inconsistencies.
The American health insurance system, more so, the public sector, entails differentiated categories of packages. The most common package is the Medicare for the elderly aged 65 years and older. The package may also include younger people with disabilities and people diagnosed with permanent kidney failure requiring dialysis or a transplant. Medicare offers a range of services including prescription drug coverage, but certain drugs such as weight loss, erectile dysfunction, and hair growth are not covered (Scott, 2016). In both countries, insurance coverage is limited to essential medical services only. Lifestyle drugs are not included in the system, thus warranting for out of pocket costs for the patients.
Healthcare systems are quite expensive, and despite the efforts in place by these two countries, financial implications are still present for the patients seeking healthcare. Financial implications generally lie in insurance coverage and out of pocket expenses for services not covered by the insurance programs. The American health care system impacts patients significantly as far as insurance coverage is concerned. Orton (2016) in his study noted that the annual premium for health insurance increased from $4,897.10 in 2013 to $6,251.96 in 2014. This was due to the adoption of the new health care system in the country. The implication was worsened by the subsequent reduction in services covered by the federal insurance. As such, services such as consultation fees were revoked resulting in the individual having to cover those costs.
Orton (2016) further notes that consultation services can rank as high as $98 per visit. Moreover, some prescribed drugs which are deemed as ‘non-essential’ are not catered for, and the patient will have to pay extra for them. The German financial implications are somewhat different as compared to the American. Insurance premiums rank at an estimate of €775 per month, with the individual paying €425 and the rest €350 covered by the employer (Klein-Hitpaβ & Scheller-Kreinsein, 2015). The premiums are relatively costly as compared to the American; however, German premiums cover a more comprehensive array as compared to the American, thereby reducing instances of out of pocket expenses.
Similarly, the German healthcare insurance cover does not entail certain prescription drugs, thereby necessitating the need for the patient to cater for them using personal finances. Some of the medicines treat chronic conditions such as weight loss and erectile dysfunction and can, therefore, have a significant implication on the overall quality of life of the patient. Studies suggests that some patients may forego the purchase of a drug if it becomes too expensive or limit the purchase to a fraction of the dose. This leads to ineffective treatment and can aid the reoccurrence of the particular malady on a future date.
A further similarity exists in how the two countries accommodate preexisting medical conditions. Pre-existing medical conditions entail health parameters that an individual has before the start date of a new health coverage period, such as diabetes, cancer, and mental disorders. Both countries have formulated rules that prevent discrimination in healthcare delivery for persons with prior medical conditions. For instance, the American government has a law that forbids insurance companies to refute or overcharge a client solely based on their existing medical condition (Assaf et al., 2017). In Germany, the situation is no different since the government dictates that all individuals should possess health insurance. The government in Germany allows the insurance providers to only charge the maximum allowable tariff for any existing condition.
This means that in both countries, mental health is a vital aspect that is accommodated by both healthcare systems. Psychiatric conditions can at times be chronic, hence quite expensive to treat. The fact that both governments are involved demonstrates the seriousness of affordable health care as a global millennial goal. The government in both countries also plays additional roles as far as healthcare services are concerned. For instance, the German healthcare system is tightly governed by the ministry of health together with other regulatory bodies. The German department of health lays down the policies that govern the federal insurance of the country such as the exclusion of lifestyle drugs from the insurance packages.
Moreover, medication coverage in Germany is standardized and controlled by the national government. Pharmacists and physicians have access to specified software that tracks how the medication is utilized in specific administrative areas within the country. The report from the software is assessed by the national government, thus ensuring the equitable distribution of the drugs, hence adequate medical coverage in the country. Moreover, doctors in Germany require a legislative accreditation for them to practice the profession and also be in a position to treat anyone with federal health insurance, due to reimbursement policies.
Private Health insurance sellers are also available in Germany, and they play a fundamental part for the universal coverage. For instance, the economically advantaged individuals will opt for private insurance since it accrues more benefits when compared to the federal policy. Some private insurance firms cover all forms of medication, hence warranting the hefty premiums as compared to the public insurance programs. However, private insurance bodies are also controlled by the national government.
Looking at the American legislation, it similarly controls the health care system like the German one; however, the strategies implemented are somewhat different. Obama (2017) suggested that health care policies are often tied to leadership changes in the United States. This is true in that, for all policy reforms to take place, the legislative body must be involved. This is no different to healthcare policies. During the implementation of the Affordable Care Act, the government is tightly engaged to determine its effectiveness and the impact it shall have on the American people. During its implementation tenure, the ACA was still strictly controlled by the federal government, despite the states having autonomy to expand the scope of coverage and dictate the implementation procedure individually.
Moreover, public insurance packages are stipulated by the federal government. The federal government strictly controls who is eligible for the insurance packages and the premiums paid by each person. Similarly, to the German health care system, private insurance groups are also present in America and their influence is also regulated by the government. The Food and Drug Administration (FDA), is a subsidiary of the government that is tasked with the role of ensuring patient safety regarding new drug regimens. The FDA also approves drugs that are marketed within the country. It has strict measures that private companies have to comply with their products to be deemed as acceptable for human consumption (Kim & Prasad, 2015).
The private sector in the United States also plays a significant factor in the country’s health care system. The private sector mostly controls medication coverage in the United States since most pharmaceutical companies are privately owned. Drug coverage is relatively adequate; however, pricing is a factor that restricts many people from accessing the actual drugs. Alpern, Song, and Stauffer (2016) suggest that monopoly hinders access to medications for low-income individuals. The monopoly causes companies to manipulate the market value of drugs for their gain at the expense of the people. This freedom of private companies to dictate the price of their products has caused heated arguments as to whether it is legally acceptable; however, the legislation has not yet tackled this issue; thus, the ordinary citizen is the one who always suffers.
Specialist care forms a fundamental part of any health care system in the world. Specialists are relatively expensive when compared to the general practitioners, thus warranting strict measures for one to see a specialist. Insurance organizations are particular with the conditions that necessitate the need for specialist care; since they are out to make profits and this form of care limits their profit margins. In the American health care system, for one to see a specialist, a written request from the primary care doctor is required. The primary care doctor capable of making such a claim is limited to the individual’s care provider. Failure of this written request warrants failure of the insurance provider to pay for the received treatment, resulting in out of the pocket expenditures (Sommers et al., 2014). The referral request is, however, not as simple as walking into your doctor and requesting for it. It involves a cross-check with your insurance cover to see the specialist options that are covered. Once this is done, the patient is then required to personally make an appointment with the specialist and ensure that the medical records have been forwarded to the requested specialist.
Specialist care in Germany takes a different approach when contrasted to the American requirements. For instance, specialist care can be recommended by a general practitioner, as is the case for the American system. However, referrals from the general practitioner are not necessary, and patients may bypass the general doctor and head straight for the specialist. This slight variation gives Germany the upper hand when it comes to satisfactory health care delivery as compared to the United States. Significant factors play a vital role in this variation. For instance, the German health care system has had more than 100 years to mature and become sustainable, whereas, the modern American health care system is only a few decades old.
Medical malpractices are common attributes that affect both health care systems. In the United States, medical malpractice laws have been under the authority of individual states and not the national government. Medical malpractices are natively treated as crimes of injuries to people or property, commonly known as ‘tort law.’ To successfully place a lawsuit involving medical care, the affected person is expected to prove that they received low medical care that resulted in the injury (Sommer et al., 2016). The actual suit takes a substantial number of steps that can serve as loopholes for the practitioner to get away with a malpractice claim, especially since even if negligence is proven; the plaintiff is faced with the challenge of proving the injuries were as a result of the identified negligence.
In Germany, the situation is a tidbit different. The law identifies that the individual who treats a patient is liable for an error in treatment if it causes injury to the life, body or the patient’s health (Sommers et al., 2014). The medical malpractice must meet two different elements of an offense for it to be considered as medical malpractice. The factors include the liability for misconduct and the responsibility for errors made during the medical encounter. Independent reports suggest that patients complaining of negligence frequently meet the pre-identified elements, hence justice is usually passed. Looking at both scenarios, the German malpractice policies are straightforward with little room for a culprit to escape; however, they seem to be stated in a way that disadvantages a suspected physician in a bid to clear his/ her name. The American policy is structured in a manner that promotes fairness for both parties, but a plaintiff might feel disadvantaged since he/she has to prove very many aspects of the policy to warrant a conviction.
Conclusion
The German health care system has continuously evolved for over 100 years. This has given it room to steadily improve its services in a bid to ensure that all patients have access to safe and affordable health care. The system is tightly linked with the federal government. Public insurance is the most common means that ensures all citizens have access to health care services. The coverage is structured in a communist manner that provides all people have access to health care, despite their economic situation. The economically able individuals pay a more premium that facilitates low-income individuals to afford healthcare. Waiting time for a doctor’s appointment is significantly reduced in Germany, and can be as little as same day visits for a scheduled appointment. The federal government is responsible for most of the funding of the public health insurance system, accounting for 74% of the revenue. Despite this, some individuals still opt for private insurance firms since they offer comprehensive coverage when compared to the public system. Lifestyle drugs are not covered by public health insurance, hence necessitating out of pocket expenses for patients diagnosed with these conditions.
The American healthcare system is still trying to get its foot on the ever-changing field of healthcare delivery. The government has been on the forefront to ensure the smooth transition and implementation of the system. Similarly, to the German healthcare system, the American system has adopted insurance that facilitates payments of medical services. The insurance system is, however, not universal since it offers a variety of packages that cover specific demographics. Lifestyle drugs are also not covered by the national insurance policies, leading to people opting for privatized insurance. Funding for the healthcare system is individualized, with the federal government contributing a small share of the revenue incurred.
Looking at both systems, the countries are in a bid to achieve universal healthcare. Several important factors, more so, policy development, have hindered this achievement. Back to our question, which happens to be the theme of the article, the German healthcare system proves to have more benefits as compared to the American system. For instance, the premiums might be relatively hefty, but they cover a broader scope of services. Moreover, the unemployed individuals are also covered, proving it to be a universal healthcare coverage. The American system is, however, sustainable since it is individually financed. Each individual is tasked with the responsibility of identifying their insurance and paying the premiums, unlike the German system that relies on contributions from the federal government. All in all, both healthcare systems have come a long way, and they still have some way left to achieve universal healthcare coverage.
References
Alpern, J. D., Song, J., & Stauffer, W. M. (2016). Essential medicines in the United States—why access is diminishing. New England Journal of Medicine , 374 (20), 1904-1907.
Assaf, S., Campostrini, S., Di Novi, C., Xu, F., & Crawford, C. G. (2017). Analyzing disparity trends for health care insurance coverage among non-elderly adults in the US: evidence from the Behavioral Risk Factor Surveillance System, 1993–2009. The European Journal of Health Economics , 18 (3), 387-398.
Busse, R., Blümel, M., Knieps, F., & Bärnighausen, T. (2017). Statutory health insurance in Germany: a health system shaped by 135 years of solidarity, self-governance, and competition. The Lancet , 390 (10097), 882-897.
Kim, C., & Prasad, V. (2015). Cancer drugs approved on the basis of a surrogate end point and subsequent overall survival: an analysis of 5 years of US Food and Drug Administration approvals. JAMA Internal Medicine , 175 (12), 1992-1994.
Klein-Hitpaß, U., & Scheller-Kreinsen, D. (2015). Policy trends and reforms in the German DRG-based hospital payment system. Health Policy , 119 (3), 252-257
Mossialos, E., Wenzl, M., Osborn, R., & Sarnak, D. (2016). 2015 international profiles of health care systems . Canadian Agency for Drugs and Technologies in Health.
Obama, B. H. (2017). Repealing the ACA without a replacement—the risks to American health care. New England Journal of Medicine , 376 (4), 297-299.
Orton, J. (2016). The Financial and Tax Implications of the Affordable Care Act on Lower and Middle Class US Residents.
Scott, D. M. (2016). United States Health Care System: A Pharmacy Perspective. The Canadian Journal of Hospital Pharmacy , 69 (4), 306.
Sommer, S. A., Geissler, R., Stampfl, U., Wolf, M. B., Radeleff, B. A., Richter, G. M., ... & Sommer, C. M. (2016, April). Medical Liability and Patient Law in Germany: Main Features with Particular Focus on Treatments in the Field of Interventional Radiology. In RöFo-Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren (Vol. 188, No. 04, pp. 353-358). © Georg Thieme Verlag KG.
Sommers, B. D., Musco, T., Finegold, K., Gunja, M. Z., Burke, A., & McDowell, A. M. (2014). Health reform and changes in health insurance coverage in 2014. New England Journal of Medicine , 371 (9), 867-874.
