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The Health Care System in Germany – a Dinosaur in Perpetual Change

The Health Care System in Germany – a Dinosaur in Perpetual Change. Dominik Naumann – presentation made by Eckhard Metze Confederation of German Employer Organisations (BDA) Social protection. How people in Germany are insured. Compulsory vs. private health insurance system. Compulsory

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The Health Care System in Germany – a Dinosaur in Perpetual Change

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  1. The Health Care System in Germany – a Dinosaur in Perpetual Change Dominik Naumann – presentation made by Eckhard Metze Confederation of German Employer Organisations (BDA) Social protection

  2. How people in Germany are insured Dominik Naumann | The Health Care System in Germany | December 6th 2013

  3. Compulsory vs. private health insurance system • Compulsory • Income-dependentcontributions (rich poor) • Benefitsasneeded (healthy sick) „Solidarityprinciple“ • Private • Contributionsbased on individual contracts • Benefitsascontracted „Equivalenceprinciple“ Dominik Naumann | The Health Care System in Germany | December 6th 2013

  4. Background – Bismarck´s social security laws • 1883 Statutoryhealthinsurance • 1884 Statutoryaccidentinsurance • 1889 Statutorypensioninsurancescheme • 1927 Imperial Institute for Labour Exchange and Unemployment Insurance • 1995 Statutory long term care insurance Dominik Naumann | The Health Care System in Germany | December 6th 2013

  5. Financing public health insurance EmployersEmployees 50 % 50 % + 0,9 % oftheirincome • Contributionassessmentceilingat 47 250 €. • Employeeswithannualincomeabove 52 200 € andself-employedpeoplehavethechoicebetweenpublicand private insurance. • Forothers, publichealthisstatutory. But theycanhave additional private insurance, e.g. for dental prothesis. • Not employedspousesandchildrenupto 18 yearsofageor in educationpayno extra contributions. Dominik Naumann | The Health Care System in Germany | December 6th 2013

  6. The principle of self-government • Statutory Health Insurance Funds are public-law corporations. • Representatives of employers and insurants make all decisions of fundamental significance. • They represent the interests of members independent from state influence. Dominik Naumann | The Health Care System in Germany | December 6th 2013

  7. Institutions of the German health system Federal MinistryofHealth: provides legal basis, e.g. budgeting, financialequalizationamongfunds. Federal Joint Committee Establishesguidelines, approvesnewmethods National AssociationofStatutoryHealth Insurance (SHI) Funds Federal Associationof SHI-physicians Federal Associationsof SHI-Funds Associationsof SHI-physicians bargaining payments 17 Regions SHI-Funds pay contributions treatments Physician Insured persons

  8. Workplace health promotion • Occupationalsafety: Law • Worklplacehealthpromotion: Voluntary Most commonare… • canteenfood, • back therapytrainingand • relaxationtechniques. Big firmshavemorecapabilitiesthansmalland medium firms. Expendituresforhealthprotectionandprevention in 2011: 11,1 bn. € 42 % firms 36 % private households 21 % state Dominik Naumann | The Health Care System in Germany | December 6th 2013

  9. Achievements of the firms • Sicknessabsence rate verylow: 3,6 % in 2012 (5,9 % in 1970) • Occupationalaccidentsdecreasedby 43 % from 1995 to 2012 • Occupationalinvaliditydecreasedby 39 % from 1995 to 2012 But: Return on investmentforpreventionisdifficulttocalculate. Dominik Naumann | The Health Care System in Germany | December 6th 2013

  10. Politics: Redistribution in the public health insurance • Rich subsidizethepoor Taxation? • Healthysupportthe sick • Young payfortheold Intergenerational justice? • Singles subsidizefamiliesDiscrimination? • Contributionratesarerelatedtothewages, so • risingwagesleadtoincreasingnon-wage costsfortheemployerand • risingcontributionrates also leadtohigher non-wage laborcosts. • Financesofthepublichealthinsurancedepend on employment, both positive and negative. ¬ Dominik Naumann | The Health Care System in Germany | December 6th 2013

  11. Taxing Wages, OECD 2013 • A singlewithoutchildrenwithaverageincome (44 811 € p.a.): total taxwedgeincludingemployer´s socialsecuritycontributions49,7 % 2/3 1/3 Tax Social insurance contributions Dominik Naumann | The Health Care System in Germany | December 6th 2013

  12. Development of public health contributions First of January each year Source: Federal Ministry of Health, 2013. Dominik Naumann | The Health Care System in Germany | December 6th 2013

  13. Political discussion – after the reform is before the reform • Finance Private andpublicinsurers on onemarket – almostunique. More orlessredistribution? Isitsustainabletokeepcontributionsdepending on wages? Do short-time surpluses due tolowunemploymentprovokenew permanent expenditures? • Expenditures Are solidarityand personal responsibility in balance? Whichneedsarereallybasicneeds? Howcancompetitionbeimplementedtoimprovequalityandreducecosts? Howcanweensureefficientmedicaltreatment in rural areas? Hospitals: Toomany? Drugs: Too expensive? Dominik Naumann | The Health Care System in Germany | December 6th 2013

  14. Thanks for your attention Dominik Naumann | The Health Care System in Germany | December 6th 2013

  15. BDA | Bundesvereinigung der Deutschen Arbeitgeberverbände Mitglied von BUSINESSEUROPE Hausadresse: Breite Straße 29 | 10178 Berlin Briefadresse: 11054 Berlin T +49 30 2033-0 F +49 30 2033-2105 bda@arbeitgeber.de www.arbeitgeber.de

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