Health Care guaranteed – The Right to Health in Germany Which Lessons could be learned about or from Germany?

1. Health Care guaranteed – The Rightto Health in GermanyWhichLessonscouldbelearnedaboutorfrom Germany? Remarksby Franz Knieps, Managing Partner at Wiese Consult GmbH, formerDirector-general in the Federal Ministry of Health, Berlin

2. Health Care guaranteed – The Right to Health in Germany Main principles of the German health care system • Public / private mix of insurers and providers • Nearly 100% of population covered • Shared responsability of federal, state, community authorities • Dominant role of self-administration, weak role of the state • 11% of GDP for health care costs • Wide range benefit package • Comparable low co-payment level

3. Health Care guaranteed – The Right to Health in Germany Legal framework • Norightto health in Basic Law (Constitution), but deductedfrom the right of life • Guaranteedby the Social Code andbyjurisdiction of the Constitutional Court • Protectedby Anti Diskrimination Law and the jurisdiction of Federal and State Courts • Supervisedby Federal and State Insurance Authorities • Violationspunishedbyfederaland professional laws

4. Health Care guaranteed – The Right to Health in Germany Real situation – Strengths • No formal hurdles to access for the whole population • Free choice between funds and providers • Indications for oversupply and information overkill • No formal waiting lists (except transplantations) • Easy access to medical, technical, pharmaceutical progress • Strong legal position of patients and insured

5. Health Care guaranteed – The Right to Health in Germany Real situation - Weaknesses • Health statusdepends on socialstatus (income, education, origin) • Variations of careand lack of integrated of service • Focus on acutecareand dominant role of physiciansesp. specialists • Providers favourprivatelyinsured • Lack of (written) patientrightsand health policystrategies • Neglecting • Primary careesp. In rural areas • Access for (illegal) migrants • Children in poverty • Mental diseasesesp. Dementia • Also indicationforoversupply • Information overkill

6. Health Care guaranteed – The Right to Health in Germany Future challenges • Demografic change • Population • Health professionals • Cost of medical progress • Globalization and Migration • Urbanization • Ethics • Sustainable financing

7. Health Care guaranteed – The Right to Health in Germany Possibleanswers • Common insurance market forpublicand private insurers • Focus a (national) public health strategy on • Preventionand health promotion • Evidencebasedcare • Chroniccare, rehabilitation, longtermcare • Outcomemeasurementandpayforperformance, especiallyfor vulnerable groups (e.g. children, migrants, poor, elderly) • Passing a patientprotectionlaw • Improving health educationandpatientcoaching • Patient empowermentandshareddecisionmaking • Developingnewmodels of (integrated) carefor the wholepopulation