Back to Europe: Back to Bismarck?

1996 ◽  
Vol 26 (4) ◽  
pp. 777-802 ◽  
Author(s):  
Hans-Ulrich Deppe ◽  
Stjepan Oreskovic
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Service Provision ◽  
Health Care Systems ◽  
Insurance Companies ◽  
Central State ◽  
German Health Care System ◽  
German Health ◽  
Care Systems ◽  
Care System

Since 1989 there have been enormous changes in all aspects of health policy, and the Former Socialist Economies (FSEs) are facing similar challenges. The general restructuring of politics and economies has resulted in two leading orientations in the transformation of health care systems: the separation of funding and service provision from the state, and the separation of funding and service provision from each other. Many FSEs have already passed legislation establishing a sickness insurance system under a single national funding institution, or a combination of compulsory and voluntary insurance, or a system involving private sector insurance companies in generating compulsory or voluntary health care funding. Due to the peculiarities and specific features of the German health care system, the uncritical intention to implement the “Bismarck model” in the FSEs faces several problems. These can be summarized in one main point: the relative stability of the German health care system, which may be attractive to the FSEs, is based on economic prosperity and on a strong ability to assert the will of the central state institutions; these preconditions are not present in the FSEs.

scholarly journals Measuring efficiency of the German health care system from the population perspective

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Köppen ◽  
K Achstetter ◽  
M Blümel ◽  
R Busse
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Providers ◽  
Health Care Systems ◽  
Care Providers ◽  
German Health Care System ◽  
German Health ◽  
Measuring Efficiency ◽  
Care Systems ◽  
Care System

Abstract Background Human and financial resources in health care systems are limited and require efficient use. Efficiency is one of the final goals of the WHO Health Systems Framework but measuring efficiency and finding room for improvement is complex; a rarely used approach is the assessment from the population perspective. This study aims to analyse, if inefficiencies in the German health care system are present and can be identified by the population. Methods In 2018, a survey was conducted with a random sample of 20,000 insured persons of a German private health insurance (PHI) company. Three aspects of efficiency were operationalized in the questionnaire: self-reported duplicate tests, prescription of unnecessary health services, and adequacy of insurance premiums. Results are based on descriptive analyses. Results In total, 3,601 respondents (age 58.9 ± 14.5; 64.9% male) were included (18.0%) in the analyses. Efficiency was rated as follows: 20% of respondents experienced duplicate tests due to a lack of coordination between physicians. This rate was even higher (38%) among those who perceived (very) poor/fair coordination. Unnecessary services (self-assessed) were prescribed to 22% of all respondents and was 50% among patients who experienced that physicians' consultations and treatments were led by motives other than the patients' wellbeing. A total of 33% rated their premiums as (too) high, 63% as fair and 4% as (very) low with differences according to income, sex and health status. Conclusions From a population perspective, the German health care system has the potential to be more efficient e.g. by reducing duplicate tests. Patients with PHI experience unnecessary services and duplicate tests, which put a strain on both, the already limited financial and personnel resources on a macro level, and the level of the individual PHI premium. Key messages Patients perceived tests or services as unnecessary, and hence, can detect inefficiencies of a health care system. Efficiency can be improved e.g. by a better coordination of care between health care providers.

Vertragswettbewerb im Gesundheitswesen / Double-sided Competition for the German Health Care Market

2007 ◽  
Vol 227 (5-6) ◽  
Author(s):  
Axel Börsch-Supan
Keyword(s):  
Health Care ◽  
Market Power ◽  
Health Care System ◽  
Oecd Countries ◽  
Insurance Companies ◽  
Health Care Market ◽  
Healthy Life ◽  
German Health Care System ◽  
German Health ◽  
Care System

SummaryGermany spends more than 11% of GDP on health care - after the US and Switzerland the third most expensive system in the world. At the same time, healthy life expectancy is just about average among the OECD countries. This indicates that the German health care system suffers from inefficiency. Other OECD countries, notably Sweden, achieve much higher healthy life expectancies at considerably lower costs.This paper addresses how the efficiency of the German health care system should be improved upon. Our central argument departs from the well-known observation that information about efficient health care procedures and technologies is asymmetric: insurances know better than consumers which doctors and hospital deliver high quality at lower prices. Hence, the role of health insurances as information mediators between consumers and providers is crucial. Thus, on the one hand, health insurances should gain more market power in the provider market, in which insurance companies pay the services of doctors and hospitals, in order to control costs. One the other hand, however, this increased market power in the provider market needs to be counter-balanced by more competition in the insurance market, in which consumers purchase insurance policies. This requires free choice of consumers among insurance contracts with different prices.

scholarly journals Unmasking a health care system: the Dutch policy response to the Covid-19 crisis

2021 ◽  
pp. 1-10 ◽  
Author(s):  
Iris Wallenburg ◽  
Jan-Kees Helderman ◽  
Patrick Jeurissen ◽  
Roland Bal
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Health Care System ◽  
Health Care Systems ◽  
Economic Policies ◽  
Hard Time ◽  
Dutch Health ◽  
Care Systems ◽  
Policy Systems ◽  
Care System

Abstract The Covid-19 pandemic has put policy systems to the test. In this paper, we unmask the institutionalized resilience of the Dutch health care system to pandemic crisis. Building on logics of crisis decision-making and on the notion of ‘tact’, we reveal how the Dutch government initially succeeded in orchestrating collective action through aligning public health purposes and installing socio-economic policies to soften societal impact. However, when the crisis evolved into a more enduring one, a more contested policy arena emerged in which decision-makers had a hard time composing and defending a united decision-making strategy. Measures have become increasingly debated on all policy levels as well as among experts, and conflicts are widely covered in the Dutch media. With the 2021 elections ahead, this means an additional test of the resilience of the Dutch socio-political and health care systems.

scholarly journals The nursing shortage: a worldwide problem

2002 ◽  
Vol 10 (3) ◽  
pp. 392-400 ◽  
Author(s):  
Rachel Z. Booth
Keyword(s):  
Health Care ◽  
Work Environment ◽  
Health Care System ◽  
Health Care Systems ◽  
Developed Countries ◽  
World Health ◽  
Insurance Companies ◽  
Advisory Group ◽  
Positive Effects ◽  
Care System

A worldwide shortage of nurses has been acknowledged by the multidisciplinary Global Advisory Group of the World Health Organization. The shortage is caused by an increased demand for nurses, while fewer people are choosing nursing as a profession and the current nurses worldwide are aging. The shortage applies to nurses in practice as well as the nurse faculty who teach students. The inter-country recruitment and migration of nurses from developing countries to developed countries exacerbates the problem. Although public opinion polls identifies the nurse as the person who makes the health care system work for them, the conditions of the work environment in which the nurse functions is unsatisfactory and must change. Numerous studies have shown the positive effects on the nurse of a healthy work environment and the positive relationships between nursing care and patient outcomes. It is important that government officials, insurance companies, and administrators and leaders of health care systems acknowledge and operationalize the value of nurses to the health care system in order to establish and maintain the integrity and viability of that system.

scholarly journals Implementation of low-dose CT screening in two different health care systems: Mount Sinai Healthcare System and Phoenix VA Health Care System

2021 ◽  
Vol 10 (2) ◽  
pp. 1064-1082
Author(s):  
Claudia I. Henschke ◽  
David F. Yankelevitz ◽  
Artit Jirapatnakul ◽  
Rowena Yip ◽  
Vivian Reccoppa ◽  
...  
Keyword(s):  
Health Care ◽  
Healthcare System ◽  
Health Care System ◽  
Low Dose ◽  
Health Care Systems ◽  
Ct Screening ◽  
Low Dose Ct ◽  
Care Systems ◽  
Va Health Care System ◽  
Care System

scholarly journals Utilization, satisfaction and barriers of medical care among adults of Turkish descent in Germany

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
C Dornquast ◽  
S Solak ◽  
M Durak ◽  
L Krist ◽  
K H Jöckel ◽  
...  
Keyword(s):  
Health Care ◽  
Cohort Study ◽  
Medical Care ◽  
Health Care System ◽  
Self Report ◽  
German Health Care System ◽  
Screening Programs ◽  
Preliminary Results ◽  
German Health ◽  
Care System

Abstract Background The growing proportion of people with a migration background poses major challenges for public health and the health care system in Germany. People of Turkish descent represent the largest group within this specific population. The aim of this study was therefore to examine the use and satisfaction of medical services and barriers to health care access among adults of Turkish descent in Germany. Methods A cohort study of a group of nearly 1200 Turkish adults in Berlin and Essen constitutes the basis of this analysis. The baseline examination was carried out as part of the pretests of the German National Cohort study. This follow-up survey assessed utilization, satisfaction and subjectively perceived barriers in the German health care system, as well as socio-demography, lifestyle, health status and quality of life via self-report (paper based or online) in Turkish or German. Descriptive preliminary results are presented in this abstract. Results The first 287 participants interviewed until December 31, 2018 were on average 49 years old, with 64% being female. 90% of the participants had a family doctor and in the last 12 months, 17% were in a hospital for in-patient treatment and 23% in an emergency room. The use of screening programs varied from 15% (skin cancer screening) to 87% (mammography). The most frequently visited physician was the general practitioner (86%). The participants were satisfied regarding many aspects, with the best values for the communication with their doctor. However, 22% reported problems or barriers in the context of medical care in the last five years. Conclusions These preliminary results provide a first insight into the utilization behaviour among adults of Turkish descent, their satisfaction as well as barriers with the German health care system. However, possible consequences of our study should only be discussed after all analyses have been completed. Key messages This is one of the few cohort studies in a migrant population in Germany. Knowledge of barriers could provide indications of problems of adults of Turkish descent in the German health care system.

Sign in / Sign up

Export Citation Format

Share Document