REINHARDT and GERMAN HEALTH CARE

I intend to write a series of articles on various national health care systems. I would first start with the author of the “Reinhardt Report”. I first heard Uwe Reinhardt speak about government sponsored health care over 25 years ago at an AMA annual meeting.

Uwe Reinhardt describes himself as the leading expert in Health Care economics. He is Professor of both Political Economy and Economics at Princeton University. He has been an in demand public speaker for many years. His usual fee per speaking engagement runs between $5000 and $30000.

It would be interesting to know the budget of that Commission whose excellent report was completely ignored by the Commissioner of DHSS. Did the members of the "Reinhardt Commission" receive compensation for their time and efforts? Or did those who were not State employees serve pro bono? Since the document they produced was so outstanding I hope they were rewarded for their time.

Reinhardt has always been an outspoken advocate of “universal health care”. Even when I first heard him speak he showed a great affinity for the then “West” German Republic Health Care system He does acknowledge that all things are not created equal and that also applies to health care systems.

That system is unique, and actually is one of the best governmental healthcare systems in the world. However, it is not as flawless as Reinhardt describes. The hospitals are usually privately owned clinics. Except for some specialists who have an outside practice only hospital-based physicians can treat patients in a specific hospital. The patient has little or any choice about his hospital physician.

Because the general practitioner do not treat patients in the hospital, there is a loss of continuity of patient care. Under these conditions patients tend to become “ cases” not “persons”. It is a perfect Town/Gown situation and not conducive to the patient/physician relationships that Americans enjoyed up until the advent of “managed care”

The country is devided into regional “Sickness Units”. There are about 300 separate Sickness Units in Germany at the present time. Physicians are reimbursed by sickness funds via their Regional Physician Associations, which negotiates a fee schedule with the local Sickness Unit. People who have opted for private insurance, however, generally pay by invoice for treatment received.

As of 2004 the system was mandatory for employed Germans earning less than €3862 Euros per month. The 2 million civil servants and those earning more than the minimum amount are exempt from mandatory participation. About 10% of the rest of the Germans voluntarily participate in the plan. The payroll deductions or premium cost for the individual plan is based on income with the average payroll deduction of about 14%, which the employee and the employer split equally.

A distinction is made between those who have previously been employed and those who have not. The majority who had previously worked are included in the national insurance system, but instead of the employers paying, the benefits agency pays the premium.

For unemployed people who have never worked (about one-third of the unemployed in Germany) provision is made through a social fund (the Sozialamt) which arranges cover directly with doctors or through one of the AOKs (Allgemeine Ortskrankenkasse) the local funds of last resort which cover about one-third of the population.

The patient is free to see any primary care physicians or specialist participant in his sickness unit, and needs no referral to a specialist. It is noted that patients who have such a large amount of money deducted from their paycheck are very demanding in their care. They are also too frequent users of the service which can overload the system. The patient can also complain about delays in service, waiting for appointments, rude office employees and anything else they wish about the physician or his office to the Sickness Unit.

Yes, they West German health care system is one of the best. There are shorter waiting times for definitive treatment or elective surgery than in any other managed health care system. Patient satisfaction is one of the highest in Europe.

I intend to discuss as I understand them the Danish, Swedish, French, UK, and Canadian programs separately in the near future. I would hope that there will be input from anyone who desires.