German Health Reforms In 1993: New Cost Control Initiatives (Google eBook)

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DIANE Publishing, Jan 1, 1994 - Medical - 55 pages
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Examines recent German health care reform initiatives and reports on: reasons for the German reforms, nature of the reforms, initial reaction and expected effects of the reforms, and potential implications for U.S. reforms. Charts and tables.
  

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Page 4 - ... 21, 1993, exchange rate of DM 1.58 per US dollar was used for all conversions in this report "Only about 10 percent of the German population are not members of one of these sickness funds — about half of this group have incomes above the statutory ceiling and choose to purchase private insurance. Most of the rest are civil servants and public employees who participate in a special plan that covers 50 to 80 percent of their health care costs, which is often augmented to 100 percent coverage...
Page 42 - In addition, a rise in contribution rates tended to increase already high labor costs in Germany and thus the price of products. The sickness funds recognized that their budgets for prescription drugs and dental care were rising too rapidly due to high prices and excessive volume. A concern existed that expenditures in the hospital sector were excessive due to a lack of incentives to control costs. Past reforms to improve hospital management were not very effective because of states' reluctance to...
Page 10 - In addition to these expenditure caps, these reforms shifted some costs to patients by introducing copayments and also instituted quality assurance measures. Our earlier work on German reforms indicated that the tougher budget controls on physician spending were successful in reducing real spending by as much as 17 percent between 1977 and 1987. Hospital budget controls, however, failed to contain spending because capital costs were excluded and a formal mechanism to insure compliance was lacking....
Page 6 - The premium contribution operates much like a payroll tax where a fixed percentage of the employee's gross compensation is deducted from each paycheck and transferred directly to a nonprofit sickness fund. The 1993 contribution rate...
Page 5 - LKK) covering farmers and one national fund each for maritime workers (Seekrankenkassen— See-KK) and miners (Bundesknappschaft — BKnsch). "The substitute funds for salaried workers (Verband der Angestellten Krankenkassen) have almost all the members compared to the substitute funds for wage earners (Arbeiter Ersatzkassen Verband). German law requires the sickness funds to provide a comprehensive benefits package that covers most health care costs with little or no copayment by members. Covered...
Page 5 - Covered benefits include ambulatory and hospital care; maternity, dental, physical therapy, and preventive care; drugs; family planning; rehabilitation; eyeglasses; medical appliances; home health care; and fitness tests and work therapy, including spa visits as part of work therapy. The health insurance benefits also include cash allowances for maternity leave, paid leave for care of a sick child, sick leave, and burial allowances. Presently, the sickness funds do not cover long-term nursing home...
Page 9 - ... the reforms. This review also builds on previous GAO studies of the German health care system and information obtained from our current work on five other international comparative studies for the Congress.6 While the former West German health care system now covers the entire country, this report focuses on conditions that existed and changes occurring in former West Germany, which provide a better basis for comparison with the United States. More detailed information on the structure of the...
Page 9 - ... funds, that is, basing increases on the gross wages and salaries of the members. In 1977 federal law established Concerted Action, a biannual assembly of major players in the health care system, to establish broad guidelines for the nation's health care system.7 Concerted Action first established global budget targets for regional associations of physicians, though these targets were benchmarks or guidelines and not legally binding. In addition, reforms included a In addition to published reports,...
Page 12 - In addition, incentives existed for physicians to provide technical services, such as laboratory tests and diagnostic procedures, because they received additional reimbursements from the sickness funds for these services. The 1993 reforms aim to reduce excess service volume and overuse of technical services by physicians authorized to treat sickness fund members. To enforce the law, representatives from the regional associations of physicians and sickness funds plan to continue their oversight of...
Page 17 - ... prescribed. Despite the protests of some groups, the Federal Ministry of Health is already considering another round of structural reforms. The Ministry has instructed the expert council to the Concerted Action committee to submit preliminary suggestions by December 1993 on further restructuring of the health care system, with a final proposal due by the end of 1994. The Ministry contends that, while the 1993 cost-cutting measures appear successful, additional reforms must address demographic...

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