German Health System Not Quite in Intensive Care

In a 2000 report conducted by the World Health Organization (WHO) on global health care, Germany ranked 25th out of 191 countries based on a cost-effectiveness ratio, coming in before the USA (37) and Canada (30). In another study, carried out by the Frank Beske Institute for Health System Research in 2005, Germany came in first among 14 industrial countries regarding health-care services available to the insured.

Part of the reason for that is the dense network of doctors, dentists, hospitals and private practices around the country. According to WHO statistics, Germany has around 358 doctors per 100,000 inhabitants, well ahead of the US, with 279 and Canada, with 229. Health-care coverage, while not universal, comes close.

But ask Germans about their own system and they are usually quick to judge it wanting. One survey conducted by the Commonwealth Fund, an American health care foundation, found that 55 percent of Germans thought the system needed fundamental reform.

Americans on the other hand, 15 percent of whom are uninsured and who have a health-care system widely seen as both inefficient and expensive, rate the system better. More than 50 percent of Americans rate the US health-care system as "excellent"; only 35 percent of Germans would give their own system such high marks.

"We complain a lot about a very good system of health care," said Volker Bahr of the Fritz Beske Institute for Health System Research, whose institute put together the comparative report on health care in 14 western countries.

"If I had a fantastic insurance plan and economic means in the US, then I would have fantastic treatment," he added. "But when it comes to the average Joe, he's often better taken care of in Germany."

The institute's report found that "as demonstrated in international comparisons, Germany has a comprehensive, inexpensive system with an above-average efficiency rating."

Others take a slightly less rosy view, pointing to the fact that Germany's system is costly. In a global comparison, the country spends more on health care than any other country besides the United States and Switzerland.

"The quality in Germany is not bad at all, even though in looking at the costs, it might be better," said Boris Augurzky, head of the health care department at the Rhineland-Westphalia Institute for Economic Research. "Still, Germans almost never have to put up with long waiting times for treatment like they do in England or Scandinavia."

But media reports often paint a different picture, depicting a system that is ailing, past its prime and teetering toward collapse. Health-care reforms enacted over the past several years, which introduced a nominal co-pay for doctor's office visits and made some changes to drugs covered by public health plans, have unleashed widespread anger among the populace and only deepened public dissatisfaction with a system that statistics and health-care professionals say is still one of the best.

Weak points

That is not to say that the country's health-care system does not have its problems, particularly when it comes to long-term financing. Right now, the system is supported for by contributions from workers, who generally pay around 14 percent of their wages for health care. But Germany's stubbornly high unemployment rates have meant less money is going into the system.

On Monday, the president of one of Germany's leading doctors' organizations, the Bundesärztekammer, warned that Germany could be on its way to emulating the United States when it comes to medical care for the poor. The number of people without medical insurance in Germany has risen above the 200,000 mark, with some suggesting that number could reach as high as 250,000.

"'American-style conditions' are used by many people to paint a horror scenario about health care here," said Dr. Hans-Jürgen Marcus, spokesperson for the National Conference on Poverty in Germany, especially given the fact that some 45 million in the United States are uninsured.

"No one can seriously say we have a bad system, but we're seeing more holes developing in the net, that's for sure," he said. "We have to watch out for that."

Worrywarts?

Germany's federal government has made health-care reform one of its priorities and is now working on hammering out a strategy to increase competition and efficiency, cut costs, and ensure the system's long-term financial stability.

But the word "reform" tends to make Germans nervous since it is perceived as meaning that something one previously had is about to be taken away. In some respects, that will likely be the case, according to Jeannette Arenz, head of the health care department at the Paritätischer Wohlfahrtsverband, a leading umbrella group for German charitable organizations.

She doesn't worry about an overall degradation of basic health care, which she, like other experts, categorizes as good. But she does see a tendency towards higher co-payments and more services that will not be covered by insurance plans in the future.

She does agree that more people are falling through the cracks of the system these days, and the numbers of uninsured are rising. But on a trip to Brussels last week, she came across a study which found that among Europeans, Germans are the most dissatisfied with their own system, although many studies show it to be among the best in Europe.

"I think it's because Germans want to feel 100 percent secure when it comes to health care," she said. "And that's just not possible anymore."