Germany - National Health Insurance and Medical Care

In early 1993, the Health Care Structural Reform Act (Gesundheitsstrukturgesetz--GSG) came into effect, marking the end of a more than a century-long period in which benefits and services under statutory public health insurance had been extended to ever larger segments of the population. Rising health expenditures may prompt policy makers to impose further restrictions on providers and consumers of health care. These high expenditures have been caused by a rapidly aging population (retirees' costs rose by 962 percent between 1972 and 1992), the intensive and costly use of advanced-technology medical procedures, and other economic and budgetary pressures. As of mid-1995, the drafting of new reform proposals was under way.

Although the federal government has an important role in specifying national health care policies and although the L�nder control the hospital sector, the country's health care system is not government run. Instead, it is administered by national and regional self-governing associations of payers and providers. These associations play key roles in specifying the details of national health policy and negotiate with one another about financing and providing health care. In addition, instead of being paid for by taxes, the system is financed mostly by health care insurance premiums, both compulsory and voluntary.

National health insurance and medical care

Germany's health care system provides its residents with nearly universal access to comprehensive high-quality medical care and a choice of physicians. Over 90 percent of the population receives health care through the country's statutory health care insurance program. Membership in this program is compulsory for all those earning less than a periodically revised income ceiling. Nearly all of the remainder of the population receives health care via private for-profit insurance companies. Everyone uses the same health care facilities.

For residents of the former GDR, the era of free care ended in 1991. The political decision to adopt the FRG's health care system required the reorganization of nearly all components of health care in the new L�nder . As of mid-1995, the reorganization of the health care system in the former GDR still was far from completion.

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