How the state employee insurance works
Prof. Dr. Dr. Thomas Gerlinger is professor at AG 1: Health Systems, Health Policy and Health Sociology at the Faculty of Health Sciences at Bielefeld University
Prof. Dr. Wolfram Burkhardt is a professor at the University of Applied Sciences in Frankfurt am Main in the field of social work and health
Health systems have grown historicallyThe peculiarities of one's own country can be seen particularly well if one looks at how other countries solve the corresponding tasks. This is especially true for the health sector. The health systems of the European and non-European industrialized countries sometimes differ greatly from one another, although ultimately the same tasks of health care are at stake everywhere.
Health systems in other European countries
The reason for the differences is the strong historical character of the interaction between the various professional groups and institutions, the distribution of tasks and the financing of the health system in the individual countries. Health systems are not designed by experts on the drawing board, but develop in long-term and nationally different historical-political processes.
Using the example of the German health care system, it can be observed how permanent such influences are and how tenacious some decades-old structures are, even though they have long ceased to be considered contemporary solutions.
In the following, some salient features of the German health system are described in their historical context. Above all, they relate to control and decision-making as well as fundamental organizational issues in medical care. Knowledge of these peculiarities is essential for understanding many current problems and political disputes in German health policy.
Bismarck's social securityAs part of the social legislation initiated by Reich Chancellor Otto von Bismarck, statutory health insurance was established in 1883. One of the most important characteristics of the German health system is linked to this founding act: the financing of medical care for the majority of the population through social insurance.
One criterion that is often used in international comparisons of health systems is the predominant mode of financing:
- In state-funded health systems, the funds are raised primarily through general taxes. Examples of tax-financed health systems are Great Britain, Sweden, Denmark, Ireland, Greece, Spain, Italy.
- In social security systems - because of their historical origin, they are sometimes referred to internationally as "Bismarckian systems" - health services are financed through insurance contributions from citizens to state-regulated and supervised insurance systems. Examples besides Germany are France, Austria, the Netherlands, Belgium, Luxembourg and Japan.
- "In systems oriented towards the market economy, the financial protection of the risk of illness takes place to a considerable extent through private insurance companies. The most important example of this type is the USA."
"Basic principles of statutory health insurance"
Overview of the health fund
Statutory health insurance plays a dominant role in the German health system: around 90 percent of the population have statutory health insurance and almost 60 percent of total health expenditure is borne by the statutory health insurance.
The functional principles of the statutory health insurance as well as the relationships between statutory health insurance and service providers - doctors, hospitals, pharmacies, etc. - therefore exert a significant influence on the German health care system and its most important actors.
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