German Medical Association

Transcription

1 German Medical Association Federation of the German Chambers of Physicians The German Health Care System Workshop of the Serbian Medical Chamber 08 February 2018 Dr. Ramin Parsa-Parsi Head of the Department for International Affairs German Medical Association 2018

2 Basic Features North Rhine- Westphalia Rhineland- Palatinate Saarland Schleswig- Holstein Bremen Lower Saxony Hesse Baden- Württemberg Hamburg Thuringia Mecklenburg Western Pomerania Saxony- Anhalt Bavaria Berlin Brandenburg Saxony Ø Public health is mainly the competence of the 16 federal states Ø Compulsory statutory health insurance for employees (Bismarck Model) Ø Private / public mix of providers and payers Ø Self-governance of physicians and statutory health insurance funds 2

3 Healthcare Expenditure Schleswig- Holstein Bremen Lower Saxony Hamburg Mecklenburg Western Pomerania Berlin Ø Population million Ø GDP per capita 37,947 North Rhine- Westphalia Rhineland- Palatinate Saarland Hesse Thuringia Saxony- Anhalt Brandenburg Saxony Ø Expenditure on healthcare: 4,213 per capita ~ 11.3 % of GDP billion per annum Baden- Württemberg Bavaria Daten 2015 Quelle: Statistisches Bundesamt, statista.com, 3

4 Total Healthcare Expenditure Total healthcare expenditure: 344 billion Euro Daten 2015, Quelle: Statistisches Bundesamt 2017: Fachserie 12 Reihe Gesundheit: Ausgaben

5 Sources of Finance Ø 58.1% of total healthcare expenditure financed through statutory health insurance (~6.6% of GDP) Ø 13.4% financed by private households, including direct payments and copayments Ø 8.9% financed by private insurance Ø 8.1% financed by long-term care insurance Ø 4.4% financed by public sources Data: 2015, Source: Statistisches Bundesamt 2017: destatis.de 5

6 Insured Persons Statutory health insurance: ~ 71.9 million ~ 89.1% Private health insurance: ~ 8.8 million ~ 10.9% Data: 2015, Source: GKV Spitzenverband Kennzahlen der gesetzlichen Krankenversicherung 6

7 Statutory Healthcare Expenditure Total expenditure: billion Euro Data 2015, Source: GKV-Spitzenverband 7

8 Statutory Health Insurance Membership & Contributions Ø SHI membership is mandatory for employees whose gross income does not exceed a certain level ( Versicherungspflichtgrenze ): 59,400 per year or 4,950 per month (2018) Ø SHI contributions are not dependent on risk and are proportional to the gross income up to a ceiling ( Beitragsbemessungsgrenze ) of 53,100 per year or 4,425 per month (2018) Ø Contribution rate: standardized since 2015 à 14.6% of gross income Ø Contributions are shared between SHI insured employees (7,3%) and their employers (7.3%) + an additional contribution, payed solely by the employee (~1%; depending on the insurance company) 8

9 Statutory Health Insurance Membership & Contributions Income assessment ceiling: 53,100 / annum 4,425 / month Compulsory insurance ceiling: 59,000 / annum 4,950 / month / month Employee contributions (EUR / month) Annual salary (EUR) Data: 2018 Source: BMG

10 Statutory Health Insurance (SHI) Ø 88% of the population are covered by SHI (~71 million people, ~86% mandatory, ~14% voluntary) Ø Non-earning spouses and children included without any extra charge (~16.2 million) Ø Number of insurers decreased from more than 1,200 in 1993 to about 110 in 2018 Ø Free choice among health insurers Ø SHI funds are obliged to provide membership to any eligible applicant Ø Competitive disadvantages between health insurance funds compensated using morbidity oriented risk-adjustment supplements based on 80 disease groups Data: November 2017 Source: GKV Spitzenverband, Verband der Ersatzkassen 10

11 Private Health Insurance Ø ~10,6% of the population (self-employed, civil servants and high income earners) privately insured Ø ~30,3% of the population has supplementary private health insurance Ø 48 private health insurance companies (risk-oriented premiums) Ø Basic health insurance packages: - Obligation to contract without risk-adjustment of premiums - Benefits package similar to SHI - Highest premium charged must not exceed max. SHI contribution Data: 2016 Source: PKV - Verband der privaten Krankenversicherung, Statistisches Bundesamt 11

12 Healthcare System Money Flow since 2009 Private Health Insurance Employee Standard Premium Basic Private Health Insurance Providers Employer Risk-adjustment Healthcare Fund Lump-sum per member Statutory Health Insurance 12

13 Statutory Health Insurance Consumer Payments Ø Private households contribute ~ 13% to total expenditure on health (including direct payments and co-payments) Ø 10 per day as a hospital inpatient (max. 28 days) Ø Co-payments for prescription medicine (10%; 5-10 ) Ø The limit for copayments is set at 2% of annual gross household income (1% for the chronically ill) 13

14 Long-term Care Insurance Ø Mandatory since 1995 Ø Contribution rate: 2.55% of gross salary - paid equally by employers and employees % for childless - paid by employees Ø Entitlement to long-term care benefits depends on need when care is expected to be required for at least 6 months (assessed in four grades) Ø Currently 2.75 million people receive benefits every month Data: February 2018 Source: BMG 14

15 Inpatient and Outpatient Sectors Medical care in Germany has one distinctive characteristic: a double specialist track Ø Patients have a free choice of physicians Ø Patients are treated by medical specialists in both the outpatient and inpatient sectors Ø This functions according to the first outpatient, then inpatient rule Ø Strictly separated sectors However: Ø This distinction is slowly disappearing and the sectors are merging Ø The outpatient sector is growing in relation to the inpatient sector: Ø Fewer hospital beds Ø More possibilities for outpatient treatment 15

16 Healthcare Providers Inpatient Care 1,951 hospitals 6.20 beds per 1000 ALOS 7.3 days Data: 2016; Source: Statistisches Bundesamt 16

17 Basis of Outpatient Care Ø Physicians who wish to treat patients in the statutory health insurance system must be members of one of the 17 Associations of Statutory Health Insurance Physicians Ø Associations of Statutory Health Insurance Physicians (Kassenärztliche Vereinigungen): Represent the interests of SHI-contracted physicians vis-à-vis statutory health insurance funds Safeguard outpatient healthcare 17

18 Healthcare Providers Outpatient Care Ø Outpatient care is mainly delivered by private, self-employed physicians working in individual practices Ø Patients have a free choice of physicians Ø SHI members have free access to 96% of all outpatient physicians (4% are not SHI affiliated and treat only patients who are privately insured or pay out of pocket) 18

19 Healthcare Professionals Physicians in Germany (2016) Total physicians: 496,200 Practicing: 378,600 Not practicing: 117,600 other 9% Data: 2016, Source: German Medical Association, National Association of Statutory Health Insurance Physicians

20 Statutory Health Insurance Federal Joint Committee (G-BA) Ø Main decision-making entity of the self-governing bodies of service providers and health insurance funds Ø Formulates and implements in detail which services will be provided and under what conditions benefits catalogue Ø Authorised by law to issue legally binding directives Ø Established in 2004, however predecessor committees date back to the 1920s Ø Represents physicians, hospitals, health insurance funds and patients. 20

21 One World One Medical Profession Thank You! 21