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Law and the German Universal Healthcare System: A Brief Contemporary Overview

Published online by Cambridge University Press:  06 March 2019

Ursula Weide

Extract

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How to reform the American health care system, now dominated by a decreasing number of multi-billion dollar managed care corporations, has occupied the public debate for many years. Recent news reports hefty increases in managed care premiums, benefit reductions, and an ever-growing number of managed care organizations refusing to treat Medicare patients. Numerous “patients’ bills” have been submitted in Congress, attempting to rein in some of the managed care cost containment practices. None have been adopted so far. At best, such bills would superficially treat some of the symptoms of an ill-functioning health care delivery system, poorly serving the population, insured and uninsured, and creating a plethora of ethical conflicts for providers battling to preserve an acceptable standard of care. Since the Clinton health care reform efforts failed in 1994, no one has proposed a fundamental revision of the system, and the United States remains the only industrialized nation without a universal health care system. The literature mainly reports on those – English-language – countries whose cost containment measures have resulted in overburdening the public health care system. There are, however, numerous European governments which succeed in stabilizing health care expenditures by mandating some sacrifices by all participants in the health care system while preserving universal access, comprehensive coverage, and the standard of care.

Type
Developments
Information
German Law Journal , Volume 6 , Issue 8 , 01 August 2005 , pp. 1143 - 1171
Copyright
Copyright © 2005 by German Law Journal GbR 

References

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Cite as: Ursula Weide, Law and the German Universal Healthcare System: A Contemporary Overview, in: 6 German Law Journal 1143 (2005), at: www.germanlawjournal.com/pdf/Vol06No08/PDF_Vol_06_No_08_1143-1172_Developments_Weide.pdf Google Scholar

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38 Id. Art. 72(2) Sicherstellungsauftrag. SGBV, Art. 72. This concept has been the subject of heated public debate for several years as some have suggested to limit the mandate of adequate health care delivery to the sickness funds. This would provide them with bargaining power similar to managed care companies in the united states and eliminate most of physician influence.Google Scholar

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78 Bedarfsplanung. SGB V, Arts. 99-101. The main purpose of these articles is to ensure adequate access to care by making available the appropriate number of physicians but restrictions are permitted as well. See also Lang, at 120. Today, there are 375,000 physicians for close to 80 million inhabitants, yielding a statistical average of one physician per every 276 residents (1992: 321; 1970: 616). Heinz Stüwe, Traumberuf Ade? (A Dream Profession No More?) Frankfurter Allgemeine Zeitung of 30 April 2002, at 1.Google Scholar

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138 Medizinische Versorgungszentren. SGB V, Art. 95.Google Scholar

139 Integrierte Versorgung. Id., Art. 140(A). Once established, these delivery systems could resemble ambulatory care centers but also potentially involve case managers. the law allows incorporation and the involvement of management companies. again, individual contracts outside of the collective system may be concluded with the sickness funds. although already permissible under the reform of 2000, this alternative so far has found few takers. See Hiddemann/Muckel, supra, note 137, at 8.Google Scholar

140 The SGB V expressly rejects an “any willing provider” stipulation.Google Scholar

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160 these concerns are similar to those of american practitioners, and the supreme court has coined the term “Mixed Treatment and Eligibility Decisions”, implying the inseparable link between therapeutic and administrative (cost-saving) decisions, necessary for the “rationing” of health care, seen as natural by a conservative Court. Pegram V. Herdrich, 86 U.S.L.W. 4501 (12 June 2000) (No. 98-1949). 2000 U.S. Lexis 3964. In the United States, Managed Care Organizations often preauthorize or deny care, seriously limiting the clinical decision-making autonomy of providers, which is protected by law in Germany.Google Scholar