As the phrase "health-care reform"catches on in the United States, doctors and hospitals are looking at other models to see what this country can do to cut costs, cover the uninsured and still maintain a high level of medical care.
Germany, which merged the West German and East German systems in 1990, still faces financial, organizational and medical challenges, but it has created a system that provides universal coverage at a relatively low cost, according to Dr. Jur Klaus Prossdorf.
"The man who has no work and is sleeping under the bridge will still get his heart operation," Prossdorf said.
At the same time, he said the system encourages cooperation among hospitals and teamwork among doctors to ensure that patients receive good care.
Prossdorf, who heads the entire 3,500-hospital German system, was in Salt Lake City Saturday to visit Intermountain Health Care officials and local medical product manufacturers. He also promoted Interhospital, the world's largest medical products trade fair, which will be held this June in Hannover.
Ninety-one percent of Germany's citizens are covered by "sickness funds" that are paid equally by employee and employer. Workers pay an average of 6.4 percent of their income into the fund.
Sickness fund associations then negotiate with state associations of physicians to set budgets for doctors and daily rates for hospitals.
The unemployed, homeless, elderly, poor or disabled receive medical care through social security provisions.
Individuals can choose their own doctors and hospitals. Anyone earning more than $35,000 a year can leave the system and get private health care - but once you've left the public system, you can't get back in.
Prossdorf said he was eager to see how President Clinton will deal with the health-care crisis in this country. He cited figures showing that health-care expenditures here cost $2,354 per person each year, while Germans pay $1,232 per capita.
Germany also has more hospitals and hospital beds than the United States and the general hospital stay is longer, usually about 12 days compared with about seven in America. But Prossdorf said the average hospital rate in Germany is $200 a day, compared with $1,500 to $2,000 in the United States.
Prossdorf noted some things that help the Germany system:
- German courts award small sums in malpractice cases, so doctors are less inclined to order unnecessary tests to protect themselves legally.
- Patients get incentives for exercising preventive medicine. For example, someone who needs false teeth and has gone to the dentist regularly would get them free; someone who neglected dental appointments would have to pay a portion of the cost. Most employers also provide medical check-ups.
- Groups of doctors work as teams, so a second opinion is built into the system and doctors advise each other and share responsibility for surgery and other treatments.