CommonwealthFund_Hea - DESCRIPTIONS OF HEALTH CARE SYSTEMS GERMANY AND THE NETHERLANDS The German Health Care System Reinhard Busse M.D M.P.H

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The German Health Care System Reinhard Busse, M.D. M.P.H. Professor of Health Care Management Berlin University of Technology & Charité – University Medicine Berlin Who is covered? Public (“social”) health insurance (SHI) is compulsory for people earning up to around €48,000 per year, including dependents who are included in the insurance. This applies to around 75% of the population. Individuals with earnings above €48,000 per year (around 20% of the population) are currently not required to be covered. If they wish, they can remain in the publicly-financed scheme on a voluntary basis (and 75% of them do), they can purchase private health insurance, or they can theoretically be uninsured. The publicly-financed scheme covers about 88% of the population. In total, 10% of the population are covered by private health insurance, with civil servants and self-employed being the largest groups (both of which are excluded from SHI). Less than 1% of the population has no insurance coverage. From 2009, health insurance will be mandatory, depending on previous insurance and/or job status either in the social or in the private health insurance scheme. What is covered? Services: The SHI benefits package covers preventive services; inpatient and outpatient hospital care; physician services; mental health care; dental care; prescription drugs; medical aids; rehabilitation; and sick leave compensation. Since 1995, long-term care is covered by a separate insurance scheme, which is mandatory for the whole population. Cost-sharing: Traditionally, the SHI scheme has imposed few cost- sharing provisions (mainly for pharmaceuticals and dental care). However, in 2004 co-payments were introduced for visits by adults aged 18 years and older to physicians and dentists (€10 each for the first visit per quarter or subsequent visits without referral); other co- payments were made more uniform: €5 to €10 per pack of outpatient medications (except if the price is at least 30% below the so-called reference price, i.e. the maximum reimbursable amount for drugs of equivalent effectiveness, which is the case for more than 12,000 drugs), €10 per inpatient day (up to 28 days per year), and €5 to €10 for prescribed medical aids. For dental prostheses, patients receive a lump sum which on average covers 50% of costs. In total, out-of-pocket payments accounted for 13.8% of total health expenditure in 2005. Safety Nets: Cost-sharing is generally limited to 2% of household income. For additional family members, part of the household income is excluded from this calculation. For the chronically ill, the cost-sharing limit is 1%. A directive sets out the conditions for qualifying as chronically ill; since 2008 it is also necessary to demonstrate that the person has received counselling on screening measures prior to the illness. How is the health system financed?
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This note was uploaded on 02/25/2012 for the course 360 290 taught by Professor Dankelemen during the Spring '11 term at Rutgers.

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CommonwealthFund_Hea - DESCRIPTIONS OF HEALTH CARE SYSTEMS GERMANY AND THE NETHERLANDS The German Health Care System Reinhard Busse M.D M.P.H

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