The present paper is devoted to the comparison of the healthcare systems of Germany and the US. Both are federative countries that have states (provinces in Germany) with a certain level of autonomy (Mossialos et al., 2014). Naturally, their sizes are not comparable (80 million people in Germany versus 270 million people in the US), but they also have other similarities.
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In particular, they are both developed, industrial G8 countries that are moving in a similar direction concerning healthcare (Ridic, Gleason, & Ridic, 2012, p. 117). As pointed out by Ridic et al. (2012), Germany has moved further, which implies that its experience is of particular interest to the US (p. 114). In this paper, an attempt at illustrating this opinion will be made, and several aspects of the healthcare systems of the two countries will be compared and contrasted to extract possible insights and lessons.
Healthcare System Overview
The current healthcare system of Germany is based on its historical predecessor, the expansion of the “mutual aid societies,” which had been operating since the beginning of the 19th century, by the country’s first counselor, Otto von Bismark (Ridic et al., 2012, p. 114). Health insurance is mandatory in Germany, and there are two options: public (statutory) health insurance (SHI) and private health insurance (PHI).
Those who do not earn over €4,462.50 cannot opt for private insurance. There are over 130 statutory and 43 private insurers in the market that compete for customers (Mossialos, Osborn, Anderson, & Wenzl, 2014; Ridic et al., 2012). The majority of decisions and regulative activities are carried out by healthcare and insurance providers’ associations. They also regulate prices, determining the maximums to avoid their uncontrollable growth (Busse & Blümel, 2014; Mossialos et al., 2014).
In the US, the major legislative change of the past years, the Patient Protection and Affordable Care Act of 2010 has resulted in a noticeable increase in the covered population (Lovett-Scott & Prather, 2014). Despite this, in 2014, over 50% of adults were using a form of private insurance (including employee-based), and over 13% of adults remained uninsured (Mossialos et al., 2014, p. 6).
The US healthcare insurance benefits vary in federal programs; also, the states can introduce specific plans and policies. APA’s goal is explicit: to provide affordable care to everyone, which implies national coverage. As a result, it can be concluded that the US is indeed moving towards the goal that Germany has already achieved, which implies that the former can get some lessons from the latter’s experience (Ridic et al., 2012).
In the US, the key federal bodies are the National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), and the Centers for Medicare and Medicaid Services. There is less price regulation, and, as a result, the prices for healthcare in the US are noticeably higher than in other developed countries (Squires & Anderson, 2015).
The US healthcare spending is almost notorious: it is the highest in the world if the per capita indicator is considered (Mossialos et al., 2014). The spending had decreased in the aftermaths of the recession of the year 200-2009 together with that in other countries all over the world (Squires & Anderson, 2015). However, in the US, the expenditures are expected to keep increasing in the next years to constitute 19.3% of the gross domestic product in 2023 (as compared to 17.2% in 2012) (McCarthy, 2014).
Apart from the high prices, the figure can be explained by the extensive use of modern technology in US healthcare (Ridic et al., 2012). Unfortunately, though, the immense spending does not result in corresponded improvement of life quality and span with few exceptions like cancer (Squires & Anderson, 2015, p. 2). This fact indicates that spending is ineffective.
Germany has an average healthcare spending when compared to other industrial countries; in 2014, it constituted 11% of the gross domestic product, which was comparable with those of France (which, as stated by Lovett-Scott and Prather (2014) has the most admired healthcare system in the world), Denmark, Japan, and Switzerland; it was lower than that of the US by 5% (Mossialos et al., 2014, p. 7).
In the US, Medicare and Medicaid are meant to provide insurance for the elderly, disabled, and poor. There are also miscellaneous systems of subsidies, cost-sharing discounts, and exemptions that are created through federal and state programs.
In Germany, the specific payment for a person is calculated while bearing in mind the income, age, and dependants; there is a limit for maximum costs (no more than 2% of a household income), and it is lower for the chronically ill (Mossialos, Osborn, Anderson, & Wenzl, 2014; Ridic et al., 2012) There are similar maximums for the US insurance, but they are measured in dollars, not household income percent, which is why they might be less effective (Mossialos et al., 2014, p. 6).
In Germany, mental care is also financed by SHI; it is typically carried out by mental health specialists, although some non-acute cases, especially in rural areas, are treated by physicians (Mossialos et al., 2014, p. 66). In the US, insurance plans to cover treatment, drugs, emergency care and may include other benefits for mental patients (Mossialos et al., 2014, p. 156). In both countries, mental care had been developing slower than that for psychical diseases, which is why there is still some work to be done to improve its integration.
In general, the health disparities, which are a global issue (Busse & Blümel, 2014; Lovett-Scott & Prather, 2014), are regarded as national healthcare issues and are actively addressed by the US and Germany (Mossialos et al., 2014). Apart from that, the areas of healthcare that are specifically concentrated on are also similar for the countries and include women’s health, disease management, lifestyle issues, and continuous quality improvement.
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Emphasized Aspects of Healthcare
Women’s Health and Maternal Child Health
The issues of maternal and child health are included in the federal healthcare goals of both countries (Mossialos et al., 2014). However, the outcomes differ: for example, the maternal mortality ratio has been steadily but slowly decreasing in Germany in the past two decades, while in the US it has been slightly growing (Kassebaum et al., 2014, pp. 9, 11). Also, the decrease in the rate in Germany does not live up to the Millennium Development Goal of 75% reduction. It can be concluded that there is room for improvement in this respect in both countries.
In Germany, the Robert Koch Institute is the body that is in charge of infectious disease control (Mossialos et al., 2014, p. 69). There is a variety of Disease Management Programs that are deployed in Germany for particular diseases (for example, diabetes or HIV) (Busse & Blümel, 2014). These programs are approved and accredited, and then insurance companies can offer them to patients.
In the US, the CDC performs the function of the major disease management body (Mossialos et al., 2014). Among the initiatives that are aimed at disease management in the US are the Healthy People, which defines benchmarks for the improvement of various disease and other health indicators (for example, smoking) for a particular decade (Lovett-Scott & Prather, 2014).
Theory and Practice of Health Promotion
In Germany, the theory of health promotion employs the idea of care integration, healthcare technology used, quality management and clinical government, continuous education for healthcare staff, and specific guidelines for drug assessment and procedures evaluation (Mossialos et al., 2014). There is a system of 182 indicators that all the hospitals are supposed to report and publish. The Robert Koch Institute coordinates reporting, conducts surveys, and provides publicly available datasets on healthcare and health indicators.
In the US, the key health promotion bodies include the Agency for Healthcare Research and Quality (AHRQ) and the NIH. Besides, the Food and Drug Administration promotes health through its control over the quality of foods and various drugs and medical equipment. The US also adopts the ideas of quality management and care coordination and conducts comprehensive activities in research and implementation of quality improvement strategies through AHRQ, NIH, and the Institute of Medicine (a non-profit independent research organization). As for care coordination, it is being improved through the grand Accountable Care Organizations project, which presupposes the creation of networks of health care providers who are “accountable” for a particular population.
Concerning the practice and outcomes of the healthcare systems, it is impossible to define which of the two countries performs better. For example, the avoidable death rate is the lowest in Germany when compared to the majority of industrialized countries and the highest in the US.
However, some of the quality performance indicators (for example, breast cancer survival) were lower for Germany in 2014, and its immunization rate was low when compared to other industrialized countries (Mossialos et al., 2014, p. 8). It can be concluded that both countries have room for improvement concerning the quality of care, but in certain areas, their performance is exceptional.
Behavioral and Lifestyle Factors
Smoking and alcohol intake, unhealthy dietary choices and lack of exercise remain an issue for both countries since they are a preventable cause of diseases (Busse & Blümel, 2014; Lovett-Scott & Prather, 2014). Also, both countries include the promotion of a healthy lifestyle as a part of disease prevention measures (Busse & Blümel, 2014; Mossialos et al., 2014).
Their activities yield results: for example, the alcohol intake rates in the US and Germany are much lower than in Russia (Lovett-Scott & Prather, 2014, p. 257). However, the US has a serious obesity problem, which indicates lifestyle issues with its obesity rate being 30% (12% in Germany) (Lovett-Scott & Prather, 2014, p. 289).
From the analysis presented above, it is apparent that the US and Germany attempt to provide the population with healthcare in similar ways by paying the attention to similar aspects (maternal health, quality improvement, and so on) and deploying similar policies (for example, decentralization or the diversity insurance types).
Also, both countries demonstrate good performance in some areas and require improvement in others. However, the recent developments in the US healthcare legislation show that the country aims for national insurance. As a result, the experience of Germany that has already achieved this outcome is of particular interest for the US, especially since the two countries are similar in other aspects, in particular, economic and political. Possibly, by analyzing the example of the other country, the US will be able to avoid its mistakes and perform better in the areas where Germany requires improvement.
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