Germany, health care systems

One interviewee described that employer opposition to the Worker Safety Advisor scheme has halted its development across all industry sectors in the UK [395, 396]. French interviewees described several safety representative state-sponsored schemes in France, but the resources appear far more restricted than in Sweden. There was no evidence from the interviews or literature review to indicate that Germany has such a scheme. Evidence from the interviews indicates that such schemes in France and Sweden link to their strong social health care system, with very high union membership distinguishing Sweden from France. 

In 1997, health expenditures in Germany totaled 298 billion, equal to 14.2 /o of the GDP. The health care system in Germany is decentralized, and health care expenditures are covered by a variety of sources/payers. The statutory insurance system (GKV) represents the biggest proportion of the total care coverage (for almost 50 /o). Employers, government budget, private households, private insurance. 

In Germany, health insurance is provided by a privately managed insurance plan that is regulated by federal stamtes. This insurance plan covers almost 90% of the population. The health care delivery system is a mixture of private and public providers. Thus, the German health care system is not socialized medicine, and it is financed by private insurance regulated by the govermnent. 

These similarities are offset by contrasts in their health insurance arrangements, access of patients to the political process, the authority wielded by physicians, and social insurance systems. For example, health care in the United States is generally seen as a private good associated with individual choice and the availability of menus for insurance, thereby rationing care by price. In Germany, by contrast, health care is seen primarily as a right or entitlement. It serves as an instrument of broader social justice, and rationing, if at all, is controlled by providers on a local and individual level. 

Instead of (or in addition to) national budget ceilings, some countries favour a series of financial measures involving health professionals, particularly physicians and pharmacists, to make them cost sensitive. This section will consider the approach whereby individual physicians are called upon to act as fundholders, i.e. to manage a health care budget (as for instance in the UK or in Germany), as well as certain measures designed to influence pharmacists via different systems of remuneration. 

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