Introduction to the German Healthcare System

Introduction-The German Healthcare system or the health system Can be described as both self-administering and is healthcare is operated by many players and several healthcare institutions. Fundamentally, the healthcare system in Germany is divided into 3 vital areas: rehabilitation facilities, inpatient care (this includes the hospital care) and outpatient care. The institutions that are mainly held responsible for running the healthcare system in Germany encompass the representatives and associations of the self-help groups, patient organizations, Federal Ministry of Health, regulatory bodies, health insurers, professions and healthcare providers (ncbi.nlm.nih.gov 2018). The healthcare system or health system in Germany is based on four basic principles namely- principle of self-governance, principle of solidarity, funding via the premium of the insurances, compulsory insurance. The important associations, institutions and he healthcare providers are: self-help groups and patient organizations, health care professionals, pharmacy associations, healthcare professionals, public health service, pharmacist, psychotherapist, dentist, and physician chambers, hospital federation, associations of the insurance dentists, physicians, and health insurers (Mossialos et al. 2015).

The outpatient care in Germany is mainly provided by the healthcare professional, psychotherapists, dentists and self-employed doctors. Most of the dentists and the doctors have an accreditation called the statutory health insurance accreditation and this enables the dentist or the doctor to treat anyone with a statutory health insurance. Beside the individual care, care is also provided through jointly by two or more doctors. Thus, larger services are provided only through the hospitals and such hospitals are referred to as practice hospitals. Outpatient care also include the medical care provided in a hospital or at the psychiatric institutions and this does not involve the overnight stay in a hospital (Wagner et al. 2014). The inpatient care includes all the major hospitals that treat all the patients even if they do not have the private or the statutory health insurances. It has been seen that the larger hospitals have the backing of the state or the municipality. That is these hospitals receive finding by the states and the municipalities. The church run and he charity run hospitals are operated by the religious groups or by the Red Cross. There are also private run hospitals that treat patients only if they are privately insured. The hospitals are specialized and are smaller in size. There are also the provisions for the inpatients to receive the inpatient medical rehabilitation (Nimptsch and Mansky 2012). The Rehabilitation centres help and assist the patients to get well from a serious illness, improve the fitness through the methods of intensive treatments. Thus, the treatment procedures include the psychological care and physiotherapy. The provisions of rehabilitation are applied immediately after the conduct of a surgery and after releasing from the hospital stay. There are also rehabilitation facilities for the people that are suffering from addictions and illness (Köck et al. 2014). This aim of the study is to describe the health system prevalent in Germany and an evaluation of the performances of Germany over the years. The study will also emphasize on critiquing the health policies, that largely focus on the key political, economic, cultural, social and institutional factors.

Key Principles of the German Healthcare System

Key issues in Germany’s healthcare system- Germany faces several challenges that includes the rising costs of the treatment options, high cost of diagnosis, high demand for the supply of the diagnostic tools and pharmaceutical tools and along with the surgical tools, reunification, financial crisis and globalisation, high levels of unemployment, and increased burden of ageing population. Thus, it is important to mention that expensive treatment options, and expensive diagnostic options often result into increasing the rising costs. The three very vital aspects of the German healthcare system where Germany faces major challenges are the ambulatory care, hospital management and funding process, acceptance of e-health in the ambulatory care by the physicians (Dietrich and Riemer-Hommel 2012). There are other vital issues that are faced by the German Healthcare system and it includes: i) high risk of contracting the disease of diabetes mellitus type 2; ii) high rates of mortality arising from the breast cancer; iii) high levels of tobacco consumption; iv) deteriorating health at the old age (Busse and Blumel 2018).

Medical errors as a key issue in health system- the question of mal-practice, risk management and patient safety are both critical for the ambulatory health care providers and the hospitals. it has been see that the data availability on medical errors is unsatisfactory in Germany. Data accumulated from one of the healthcare institute in Germany, Robert Koch Institute documented and suspected medical errors to be about 40,000 ever year and among them about 12,000 were considered to be acknowledged of the damage claims. It has been seen that 5 to 10 percent of the patients have experienced undesirable events additionally half of them were considered to be as unavoidable. The majority of the damage claims pertain to the medical errors related to the surgical procedures. The hospital doctors face more confrontation in comparison to the physicians that are office based. While it has bene seen that the human caused damages are more frequent, and when it gets combined with the complexities in the system components, the number of the medical cases rises. Organizational deficiency is considered to be one of the most common cause of medial error and among the organizational deficiency, insufficient coordination and insufficient communication among the providers ranks highest. There are structural factors in the German Health care system that elevates the coordination problems as well as the improper management of the interfaces. Quality management in Germany has slowed down in comparison to the other developed countries that have healthcare reforms closely linked with quality management. Quality management in healthcare has been provided with a prominent role and the main emphasis is put on the cost effectiveness (Anwer, and Abu-Zaid 2014).

Outpatient and Inpatient Care in Germany

Private health insurance as a key issue in health system- data collected from micro census have highlighted that the number of people having the personal health care increased from 4 million to 7 million when calculated from the year 1975 to the year 2002. This overall highlights 7 percent and 9.3 percent of the population respectively. The number of the people that have supplementary healthcare is found to be 8 million. This is about 9 percent of the overall population and it excludes the private health insurances during the travel. Studies have indicated that the people having the private health insurances, are forced by the law to set aside a part of their income for their old age when the insurers are young (Busse et al. 2017). It has been found that Germany is one of the countries that do not include the personal health insurances in the solidarity principles. Thus the biggest question that looms over social security. The money invested in personal health insurance is lacking in the solidarity costs. One of the biggest disadvantage of the private health insurance is the rising costs along with the age. Thus, the risks associated with the procedure deter the insurers and along with it there are laws that prevent the personal health insurance holder to re-enter into the statutory health insurance under the ordinary circumstances. In order to prevent the customer to get overwhelmed by the rising costs, the private the insurers are forced to offer insurance policies that offer same benefits as the statutory health insurances and the premium is also not higher than the average contribution to the sickness funds (Brzoska 2018). In the market of the private health insurances, the premiums vary and depend largely on the medical history, sex and age at the time of underwriting. Whereas, it has been seen in the statutory health insurances that the separate premium is to be paid for the children, spouses and this makes the private health insurances comparatively attractive for both the double income and the single income couple. There are other benefits like the room for extra health insurances that cover the simple amenities like the hospital rooms with treatment facilities by the head of the service. Additionally, there are other benefits that arise from the co-payments for benefits (Hoffmann and Icks 2012).

Decrease in the taxes as a key issue in health system- Tax has long been the major source of healthcare financing. However, latest trends have shown that the over the last decade the income from the taxes has decreased. The decreasing trends have been noticed in the statutory long term care spending. The hospital financing act was introduced in the year 1972 and this emphasized on the dual financing options in the healthcare sector. This meant the investment costs are paid by the state and the federal governments, while the running costs are paid by the private patients and from the sickness funds. Thus, if the hospitals want to be enlisted for the investment costs, then it must comply with the hospital plans that are set out by the states and it is independent of the type of ownership. The mechanism is irrespective of the private ownership, non-profit ownership, public ownership (Costa-Font and Greer 2016).

Rehabilitation Facilities in Germany

Acceptance of e-health in the ambulatory care by the physicians as a key issue in healthcare- There are concerns relating to the implementation of new technology instruments in Germany and it includes the privacy and security related issues. In the implementation of e-health, survey conducted have shown that the physicians are concerned over the data security. There are other related disadvantages on the implementation of the provisions of e-healthcare and it includes the delayed feedback; negative behaviour of the stakeholders; clinical effectiveness, quality, efficiency and efficacy; system adoption, availability and deployment; liability of the physician to document all the patient related activities, passing time while using e-health services. In the daily core activities, medical activities and their proper documentation by the physician demand technical assistance for proper documentation. Thus, it is needless to say that the usefulness and the performance of the electronic health systems depend majorly on the elaborateness and the intensity of the documentation process. Even though the majority of the physicians have acknowledged the potential advantages of adopting e-health. However, the implementation of e-health has been delayed for more than 5 years due to the increased number of resistances by the physicians (Dünnebeil et al. 2012).

Healthcare cost in the elderly in Germany as a key issue in healthcare- Germany is one of the countries that is likely to be affected badly due to the increasing ageing population above the age of 65 years. It has been estimated that the ageing population will increase by 50 percent until 2030. The aggressive increase in the proportion of the elderly people have led to the serious financial and organizational challenges. The increasing number of the elderly put a pressure on the healthcare systems that are funded by both the state and the federal governments. Along with the issues related to aged care, there are other issues related to increased body mass index, alcohol consumption, and smoking behaviour. Additionally, the illness level is considered to be major determinant or a major factor in the healthcare utilization. While this in turn impedes the usage of the healthcare services pertaining to type of health insurance and income (Heider et al. 2014).

Conclusion- From the above discussion it can be concluded that the healthcare system in Germany is divided into 3 vital areas: rehabilitation facilities, inpatient care (this includes the hospital care) and outpatient care. The healthcare system or health system in Germany is based on four basic principles namely- principle of self-governance, principle of solidarity, funding via the premium of the insurances, compulsory insurance. Mal-practice, risk management and patient safety are both critical for the ambulatory health care providers and the hospitals. it has been see that the data availability on medical errors is unsatisfactory in Germany. It has been found that Germany is one of the countries that do not include the personal health insurances in the solidarity principles. Thus the biggest question that looms over social security. The money invested in personal health insurance is lacking in the solidarity costs.

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