Compare/Contrast Healthcare in Germany and USA

A Comparison of Healthcare Systems in Germany and the United States of America

The United States and Germany are both developed countries that are wealthy. In terms of the healthcare systems of both countries, there are few similarities but also major differences in access to the different populations of citizens such as the old, the retired, the unemployed, and the poor. As paradoxical as it may sound, even though the US and Germany are both developed countries as observed above they still have a good number of citizens who are either comparatively poor or unemployed. This brings about the question of social justice and equity in the access to healthcare. The ideal situation that would be expected would be for these two rich countries to have universal access to healthcare or universal healthcare coverage (UHC). However, this is not the case especially in the US which has arguably one of the most expensive healthcare systems in the developed world (Sultz & Kroth, 2018; ScienceDirect, n.d.). Comparatively, it is Germany that comes closest to what would be described as UHC (Edwards & Dunn, 2019; IQWiG, 2015). This paper discusses the similarities and differences in access to healthcare between the two countries for children, the unemployed, and the retired. These are populations that are particularly vulnerable when it comes to accessing healthcare since they cannot pay for the same.Compare/Contrast Healthcare in Germany and USA

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Comparison of Healthcare Access Between the USA and Germany for Children, the Retired, and the Unemployed

Both the US and Germany do not have a single-payer healthcare system or what would be described as universal healthcare coverage or UHC. Both have a public component funded by those employed/ taxes, and also a private component. In a nutshell, healthcare financing in the US is through taxation, social security, out-of-pocket payments, and employer-employee financing (ScienceDirect, n.d.). However, Medicare which would be the equivalent of a single-payer if empowered by legislation only pays to a limited extent for those vulnerable populations who are covered under the Patient Protection and Affordable Care Act (ACA) of 2010 (Cai et al., 2020; Sultz & Kroth, 2018; Kominski et al., 2017; Christopher, 2016; PNHP, n.d.). On the contrary, Medicare turns out to be just one public payer amongst many other private health insurance providers operating in the US as Managed Care Organizations or MCOs. This in essence means that the MCOs are competitors to Medicare in a capitalist environment of willing buyer and willing seller with no regard to social justice and equity (PNHP, n.d.).

The German system on the other hand also presents a multi-payer system but with fundamental differences. The healthcare system in Germany is what has been described as a universal multi-payer system (akin to universal healthcare coverage), as stated by Edwards and Dunn (2019). In this, there is a compulsory statutory (anchored in legislation) for persons of a certain salary and below (i.e. those who cannot afford private insurance cover). This is called the gesetzliche Krankenversicherung or GKV (IQWiG, 2015). But there is also provision for private health insurance for those Germans who earn more and can afford it. This is the private Krankenversicherung or PKV (IQWiG, 2015). In this arrangement, all employed persons irrespective of their salary contribute 7.5% of their earnings to the universal insurance fund for everyone. This is then matched by a similar amount by the employer. At the point of care, however, the person with private insurance will pay more but the person with no private coverage but depending on the universal fund will pay less. The major difference is that both will get the same quality and quantity of services, as opposed to the situation in the US. In the US, the services or medicines which cannot be paid for by Medicare under the ACA 2010 will be paid for by the consumer out-of-pocket at the same expensive market rates irrespective of their purchasing power. In Germany, however, the rich will pay more for the same service and the poor less (Edwards & Dunn, 2019; IQWiG, 2015).   Compare/Contrast Healthcare in Germany and USA

Children, the Retired, and the Unemployed

In Germany, healthcare access for these three populations is entirely free under the statutory coverage program or gesetzliche Krankenversicherung (GKV). This is in stark contrast to the US. In Germany, the unemployed, the retired, and students with no work are all covered by the GKV at absolutely no cost (IQWiG, 2018). For children, the statutory public healthcare cover or GKV covers them up to the age of 18 years. Up to the age of 12 years, the children are seen by a pediatrician, after which they start being seen by a general practitioner. All children also receive the vital childhood vaccines for free under the GKV (IQWiG, 2018).

The situation in the US for children, the unemployed, and the retired is very different. Both the unemployed and the retired in the US are expected to purchase some form of cover through Medicare according to their savings. The retired have an option of Medicare plans labelled Part A (Hospital), Part B (Medical), Part C (Medicare Advantage), and Part D (Prescription Drugs) (Probasco, 2020). The situation is no different for the unemployed in the US. They are also expected to still purchase some form of coverage using “savings” from Medicare “through the Marketplace”. Some unemployed people and children may however qualify for free coverage under the Children’s Health Insurance Program or CHIP (HealthCare.gov, n.d.). In general, children in the US qualify for either free or low cost healthcare coverage under Medicaid and/ or CHIP. What this analysis shows is that healthcare coverage in the US is not really free for any population demographic, be they children, unemployed, or retired. This is the exact opposite with Germany, as discussed above.

Coverage for Medications in both Germany and the US

As stated in the introduction, the US has one of the most expensive healthcare systems in the world. When it comes to prescription medications, even after the signing of the Affordable Care Act (ACA) 2010 and the fact that one is under Medicaid, Americans still have to pay some money out-of-pocket for medications depending on their health plan they chose. These are classified as bronze, silver, gold, and platinum. As a result, many low-income and vulnerable populations cannot afford these medications and end up not filling their prescriptions. Majority of these are poor persons with pre-existing conditions such as diabetes and hypertension (Kominski et al., 2017). In Germany unlike in the US, prescription drugs are covered by the statutory health insurance plan for those with lower incomes under the GKV plan. This is because it is part of the standard benefits accorded by the universal cover. Dental care is also part of the benefits and is free except in the case of dental prosthetics whereby the consumer pays a certain small amount. But even this amount is very small compared to the US because it is fixed by legislation (IQWiG, 2018).

Requirements to Get a Referral to See a Specialist in Both the US and Germany

In the US, one needs to get a referral letter and authorization stating the reasons for referral to a specialist from their primary care physician. It is this information that will allow the Health Maintenance Organization or HMO which is their insurance provider to either accept or refuse the referral. If they agree you then make an appointment with the specialist. The HMO is a Managed Care Organization or MCO owned by providers who refer patients among themselves at a discount (Sultz & Kroth, 2018; Charles, 2018). In Germany, the situation is similar in that your general practitioner needs to refer you to a specialist. However, those under the optional private healthcare coverage or private Krankenversicherung (PKV) can book direct appointments with specialists (IQWiG, 2018; IQWiG, 2015).

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Coverage for Pre-Existing Conditions in the US and Germany

One of the most important benefits of the Patient Protection and Affordable Care Act (ACA) or “Obamacare” is that it made it mandatory for payers to accept to pay for pre-existing conditions such as hypertension or diabetes. Provided one is covered by a particular payer, that payer can no longer refuse to pay for treatment for their pre-existing condition or refuse them its benefits (Kominski et al., 2017). In Germany, the matter of pre-existing conditions does not even arise for those under the statutory coverage gesetzliche Krankenversicherung (GKV). This is because it is meant to cover universally without discrimination. However, it is only those under the private coverage of private Krankenversicherung or PKV who may be required by their payers to pay a slightly higher premium on disclosure of a pre-existing condition. Denial of services cannot however occur as every consumer is protected by the law (IQWiG, 2018; IQWiG, 2015). Compare/Contrast Healthcare in Germany and USA

Two Financial Implications for Patients Based on the Healthcare System Differences in the US and Germany

• Poverty: In the US, many families are impoverished when a family member becomes sick and they are forced to use family resources to pay out-of-pocket to supplement what insurance is paying. In Germany, this is not the case.
• High cost of healthcare: Because the US healthcare system is capitalist in approach and nothing is really for free, it is one of the most expensive in the world and locks access to many underprivileged and low income Americans. In Germany, the cost of healthcare is affordable because the system is that of universal coverage through a multi-payer platform.

References

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Charles, G. (November 27, 2018). What is an MCO plan? https://pocketsense.com/what-is-an-mco-plan-12471581.html

Christopher, A.S. (June 27, 2016). Single payer healthcare: Pluses, minuses, and what it means for you. Harvard Health Publishing. Retrieved 19 May 2020 from https://www.health.harvard.edu/blog/single-payer-healthcare-pluses-minuses-means-201606279835

Edwards, E., & Dunn, L. (June 30, 2019). Is Germany’s healthcare system a model for the US? NBC News. https://www.nbcnews.com/health/health-news/germany-s-health-care-system-model-u-s-n1024491

HealthCare.gov (n.d.). Health coverage options if you’re unemployed. https://www.healthcare.gov/unemployed/coverage/

Institute for Quality and Efficiency in Health Care [IQWiG] (February 8, 2018). Health care in Germany: Health insurance in Germany. https://www.ncbi.nlm.nih.gov/books/NBK298832/

Institute for Quality and Efficiency in Health Care [IQWiG] (May 6, 2015). Health care in Germany: The German health care system. https://www.ncbi.nlm.nih.gov/books/NBK298834/

Kominski, G.F., Nonzee, N.J. & Sorensen, A. (2017). The Affordable Care Act’s impacts on access to insurance and health care for low-income populations. Annual Review of Public Health, 38. https://doi.org/10.1146/annurev-publhealth-031816-044555

Physicians for a National Health Program [PNHP] (n.d.). About single payer. https://pnhp.org/what-is-single-payer/

Probasco, J. (January 21, 2020). How does Medicare work after retirement? https://www.investopedia.com/articles/personal-finance/012716/how-does-medicare-work-after-retirement.asp

ScienceDirect (n.d.). Health care financing. https://www.sciencedirect.com/topics/nursing-and-health-professions/health-care-financing

Sultz, H.A., & Kroth, P.J. (2018). Sultz and Young’s health care USA: Understanding its organization and delivery, 9^th ed. Jones & Bartlett Learning.

Compare/Contrast Healthcare in Germany and USA