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Health Insurance in Germany
Some 92 percent of Germany's residents receive health care through statutory
health insurance, that is, the GKV. As of late 1992, the GKV relied on
about 1,200 nonprofit sickness funds that collect premiums from their
members and pay health care providers according to negotiated agreements.
Those not insured through these funds, mostly civil servants and the self-employed,
have private for-profit insurance. An estimated 0.3 percent of the population
has no health insurance of any kind. They are generally the rich who do
not need it and the very poor, who receive health care through social
assistance.
Sickness funds are divided into two categories: primary funds and substitute
funds. Workers earning less than the periodically revised income ceiling
are required to belong to the primary funds; those earning more than this
ceiling may be members on a voluntary basis. Some primary-fund members
have a choice of funds. Others do not and become members of a particular
fund because of their occupation or place of residence. According to figures
from the Ministry of Labor and Social Affairs for late 1992, of the six
types of primary funds, local sickness funds, then about 270 in number,
are the most important. Organized geographically, they supply about 46
percent of the insured workforce with health insurance. About 800 company-based
funds, located in firms with more than 450 employees, cover about 11 percent
of workers. Some 180 occupational funds organized by craft cover another
2.5 percent. There are three other kinds of primary funds (about two dozen
in all); they supply insurance for self-employed farmers, sailors, and
miners and cover about 4 percent of the workforce. There are also two
kinds of substitute funds; they provide health insurance to white-collar
and blue-collar workers earning more than the income ceiling. Substitute
funds are organized on a national basis, and membership is voluntary.
Such funds cover about 34 percent of insured workers.
Employers and employees each pay half of a member's premiums, which in
the first half of the 1990s averaged between 12 and 13 percent of a worker's
gross earnings up to the income ceiling. Premiums are set according to
earnings rather than risk and are not affected by a member's marital status,
family size, or health; they are the same for all members of a particular
fund with the same earnings. In a household with two wage earners, each
pays the full premium assessed by his or her sickness fund. The unemployed
remain members of their sickness fund. Their contributions are paid by
federal and local government offices, with one-third coming from local
social assistance offices. The contributions of retirees are paid by the
pensioners themselves and by their pension funds. Thus, the public health
insurance program redistributes from higher to lower income groups, from
the healthy to the sick, from the young to the old, from the employed
to the unemployed, and from those without children to those with children.
Because some funds have poorer overall health profiles than others as
a result of the occupations of their members, the number of dependents
and pensioners among its members, or other factors, premiums can range
from as low as about 6.5 percent to as much as 16.0 percent of a member's
gross earnings. To counter this inequity, a national reserve fund makes
payments to funds with high numbers of pensioners. The GSG of 1993 mandates
an equalization of contribution rates across all sickness funds by authorizing
payments to funds burdened with health risks associated with age and gender.
About 11 percent of Germans pay for private health insurance provided
by about forty for-profit insurance carriers. A good portion of those
choosing private insurance are civil servants who want insurance to cover
the roughly 50 percent of their medical bills not covered by the government.
Some sickness-fund members buy additional private insurance to secure
such extras as a private room or a choice of physicians while in a hospital.
Otherwise, the medical care provided to the publicly and privately insured
is identical, and the same medical facilities are used. Self-employed
persons earning above the income ceiling must have private insurance.
Members of a sickness fund who leave it for a private insurance carrier
will generally not be allowed to return to public insurance.
Although private insurance companies pay health care providers about
twice the amount paid by the primary sickness funds, private insurance
is often cheaper than statutory health insurance, especially for policyholders
without dependents. As is the case for members of sickness funds, employees
who have private insurance have half their premiums paid by their employers.
German private health insurance is unusual in that whatever the insured
person's age, his or her premium will remain that set for his or her age
cohort when the policy initially was taken. Premiums rise only according
to increases in overall health care costs. Policyholders generally stay
with their original policy because if they change companies, they will
pay the higher rates of an older age cohort.
* Development of
the Health Care System
* Health Insurance
* Health Care Providers
* Remuneration
of Health Care Providers
* Current Health Care
Issues
- Population
- Immigration
- Women In Society
- Marriage
- Fertility
- Mortality
- Age-Gender Distribution
- Social Structure
- Health Care
- Religion
- Urbanization
- Geography (lands,
topography and climate)
- Society (population,
religion, marriage, urbanization, social structure, immigration)
- Education (elementary,
junior, senior, vocational, higher)
- Economy (the Economic
Miracle, financial system, Bundesbank, business culture)
- Politics (government,
the Chancellor, the President, parties, Bundestag)
- Mass Media (newspapers,
radio and TV)
- Armed Forces (army,
navy, air forces, police)
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