pushpin GermanyWe kick off a series looking at healthcare across Europe with a focus on Germany. Germany is generally reckoned among the best in the world for healthcare. The OECD Health Data 2013 shows, for example, that Germany’s expenditure per capita population in 2011 was US$4,495. Although this is less than the US’s $8,508, it still compares favourably with the OECD average of $3,322. Germany’s expenditure on health services as a percentage of GDP is 11.3%, which is topped in Europe only by France’s 11.6% and the Netherlands’ 11.9%. The OECD average is only 9.3%.

And Germany seems to be making good use of this investment in healthcare. The number of physicians per 1,000 population is 3.8, with 11.4 nurses, compared with the US’s 2.5 and 11.1, and the OECD average of 3.2 and 8.7. This suggests that Germany may have valuable lessons to offer the rest of the world about making the best use of resources.

Mixed funding

Germany’s funding system is a mixture of social insurance and private healthcare insurance. Everyone who earns less than 4,125 euros per month pays into the statutory health insurance scheme, which therefore covers around 90% of the population. Those who wish to top up, or who are not covered by the scheme, use private healthcare insurance.

Healthcare in Germany is broadly divided into inpatient and outpatient care. Inpatient care takes place in three types of hospitals: public hospitals, which are run by local authorities, towns or regions (Lander), voluntary hospitals, which are run by non-profit making organisations or by the church, and private hospitals, which are run as commercial enterprises. Outpatient services are provided by independent physicians working on a freelance basis under contract to the statutory health insurer, similar to the way in which general practice operates in the UK. Anyone treating a patient who is a member of the statutory insurance fund must be registered with the regional Association of Statutory Health Insurance Physicians. So far, probably so familiar, at least to UK readers.

The training and regulation of doctors also sounds quite familiar. The German Medical Association brings together the State Chambers of Physicians, thus bringing together all physicians, since they are affiliated to the local chamber. It has several roles, including providing advice to the profession, co-ordinating the State Chambers, professional regulation, safeguarding the interests of the profession at a national level, setting out and communicating standards, providing continuing medical education and specialist training and promoting quality assurance.

This familiarity may be a reflection of the role that has been played by the European Commission in supporting standardisation across Europe. It does make sense that, since medical staff are free to travel and work across Europe, systems are also similar. This will ensure that the EU does not have to rule on any country preventing the free movement of labour.

Growing health tourism

But it’s not only healthcare professionals who are tempted to move around Europe. With Germany’s reputation for healthcare being so strong, it’s perhaps not surprising that over 80,000 foreign patients chose to be treated there last year. And as we’ve pointed out, since globalisation is one of the key trends in healthcare, this trend will only increase.

So with a social insurance-funded system, how does healthcare work for foreign visitors to Germany? English-speaking patients wishing to travel to Germany for medical treatment would do well to look at German Medical Online, which provides information about healthcare providers, specialists, travel, and accommodation. It describes itself as the ‘global medical business platform’, and perhaps gives an idea of where globalised healthcare might be heading. It states that the German Medical Council is the key contact point for patients from overseas who want to be treated in Germany. The Council represents a network of German hospitals and specialists, with the aim of ensuring the best possible medical treatment for patients from abroad. The network includes German university hospitals, state hospitals, private hospitals and individual departments and specialists within all of these. The Council provides a full service package to health tourists, to ensure that they get the care and treatment that they want.

An increasingly global business

As the world in general, and healthcare in particular, becomes increasingly global, it seems likely that more people will choose to travel for their medical treatment. And with Europe increasingly a single market for healthcare, countries need to choose whether to embrace this trend. Germany at least, it seems, is choosing to do so, with all the benefits this brings to the economy. Others might well benefit from following Germany’s example.

Image credit: Jenene Chesborough

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