lecture # 14 ( healthcare in 4 germany)

8/6/2019 Lecture # 14 ( Healthcare in 4 Germany)

1/12

Thursday, August 04,2011

1

In The Name Of Allah,the most Beneficent, the mostGracious, the most Merciful!


2/12


2

Financing Of Healthcare

Lecture # 14


3/12


Revision


4/12

Germany

Financing

Medical Care

Mode of payment to doctors & hospitals Cost Controls


5/12

Germany

Financing

1st Nation to pass compulsory health insurance

legislation in 1883.

Employers & employees are required to makepayments to sickness funds

Initially industrial wage earners less than 500 $

were included

Now about 90% Germans receive health

insurance through mandatory sickness funds


6/12

Germany


7/12

Germany

Financing continued.

Mostly people belong to same sickness funds

throughout life

Sickness funds are non profit, closely regulatedbodies that are between private & public sector.

37% people belong to funds managed by

geographical areas, 33% by substitute funds,

21% by their own employers funds (700

companies).


8/12

Germany

Financing continued.

SICKNESS FUNDS

In 2004, 14.23% of earning goes to sickness funds

(46% by employers & 56% by employees).

About 300 sickness funds in Germany

No pre-existing exclusions or increased rates

according to age or medical condition

Covered benefits are hospital & physician services,drugs, dental, preventive & maternity services.

Mostly employees contribute 7% (same contribution

by employers).


9/12

Germany

Medical Care

Strict separation of ambulatory care physicians

and hospital based physicians (so poor

coordination between the two as well)

Hospital based physicians do not have private

offices

Ambulatory care physicians cannot work in

hospitals

51% physicians are generalists (35% in USA)

No referrals required from primary care

physicians to see specialists


10/12

Germany

Payment to physicians & doctors

Ambulatory physicians join the regional

physicians association

SicknessF

unds pay a global sum each year tothe association, which in turn pays physicians

on the basis of detailed fee schedule

Next quarter payment of physicians will decrease

if services charged were high

Salary of the hospital based physicians


11/12

Germany

Cost Controls (10.7% of GDP in year 2005) Govt. passed 1977 Cost Containment Act

A body is created called Concerted Action, made

up of health providers, sickness funds,

employers, unions, and different levels of

government

Concerted Action is convened twice a year &

every spring it sets guidelines for physician fees,hospital rates, prices of pharmaceuticals & other

supplies

Based on these guidelines, negotiations are

conducted


12/12

Thursday, August 04,2011 12

Thank You

lecture # 14 ( healthcare in 4 germany)

Documents