Download German Health Policy – Focus on Drug Regulation

Health Care guaranteed –
The Right to Health
in Germany
Which Lessons could be learned
about or from Germany?
Remarks by Franz Knieps,
Managing Partner at Wiese Consult GmbH, former Director-general in the
Federal Ministry of Health, Berlin
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Health Care guaranteed – The Right to Health
in Germany
Main principles of the German health care system
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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
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Health Care guaranteed – The Right to Health
in Germany
Legal framework
 No right to health in Basic Law (Constitution), but
deducted from the right of life
 Guaranteed by the Social Code and by jurisdiction of the
Constitutional Court
 Protected by Anti Diskrimination Law and the jurisdiction
of Federal and State Courts
 Supervised by Federal and State Insurance Authorities
 Violations punished by federal and professional laws
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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
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Health Care guaranteed – The Right to Health
in Germany
Real situation - Weaknesses
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Health status depends on social status (income, education, origin)
Variations of care and lack of integrated of service
Focus on acute care and dominant role of physicians esp. specialists
Providers favour privately insured
Lack of (written) patient rights and health policy strategies
Neglecting
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Primary care esp. In rural areas
Access for (illegal) migrants
Children in poverty
Mental diseases esp. Dementia
 Also indication for oversupply
 Information overkill
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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
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Health Care guaranteed – The Right to Health
in Germany
Possible answers
 Common insurance market for public and private insurers
 Focus a (national) public health strategy on
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Prevention and health promotion
Evidence based care
Chronic care, rehabilitation, long term care
Outcome measurement and pay for performance,
especially for vulnerable groups (e.g. children, migrants, poor, elderly)
Passing a patient protection law
Improving health education and patient coaching
Patient empowerment and shared decision making
Developing new models of (integrated) care for the whole population
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