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    In The Name of Allah, The Most Beneficent, The Most Gracious, The Most Merciful!

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    The document discusses healthcare financing in Germany. It notes that Germany was the first nation to pass compulsory health insurance legislation in 1883, requiring employers and employees to pay into sickness funds. Today around 90% of Germans receive health insurance through these mandatory sickness funds. Sickness funds are non-profit organizations regulated by the government that pay doctors and hospitals for services using a detailed fee schedule. Cost controls include guidelines set every year for fees and prices by a body made up of healthcare stakeholders.

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    In The Name of Allah, The Most Beneficent, The Most Gracious, The Most Merciful!

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    sana181019811
    17 views12 pages
    The document discusses healthcare financing in Germany. It notes that Germany was the first nation to pass compulsory health insurance legislation in 1883, requiring employers and employees to pay into sickness funds. Today around 90% of Germans receive health insurance through these mandatory sickness funds. Sickness funds are non-profit organizations regulated by the government that pay doctors and hospitals for services using a detailed fee schedule. Cost controls include guidelines set every year for fees and prices by a body made up of healthcare stakeholders.

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    Lecture # 14 ( Healthcare in 4 Germany)

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    The document discusses healthcare financing in Germany. It notes that Germany was the first nation to pass compulsory health insurance legislation in 1883, requiring employers and employees to pay into sickness funds. Today around 90% of Germans receive health insurance through these mandatory sickness funds. Sickness funds are non-profit organizations regulated by the government that pay doctors and hospitals for services using a detailed fee schedule. Cost controls include guidelines set every year for fees and prices by a body made up of healthcare stakeholders.

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    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
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    17 views12 pages

    In The Name of Allah, The Most Beneficent, The Most Gracious, The Most Merciful!

    Uploaded by

    sana181019811
    The document discusses healthcare financing in Germany. It notes that Germany was the first nation to pass compulsory health insurance legislation in 1883, requiring employers and employees to pay into sickness funds. Today around 90% of Germans receive health insurance through these mandatory sickness funds. Sickness funds are non-profit organizations regulated by the government that pay doctors and hospitals for services using a detailed fee schedule. Cost controls include guidelines set every year for fees and prices by a body made up of healthcare stakeholders.

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    of 12

    In The Name Of Allah, the most Beneficent, the most Gracious, the most Merciful!

    Thursday, August 04, 2011

    Financing Of Healthcare Lecture # 14

    Thursday, August 04, 2011

    Revision

    Thursday, August 04, 2011

    Germany
    Financing Medical Care Mode of payment to doctors & hospitals Cost Controls

    Germany
    Financing 1st Nation to pass compulsory health insurance legislation in 1883. Employers & employees are required to make payments to sickness funds Initially industrial wage earners less than 500 $ were included Now about 90% Germans receive health insurance through mandatory sickness funds

    Germany

    Germany
    Financing continued. Mostly people belong to same sickness funds throughout life Sickness funds are non profit, closely regulated bodies that are between private & public sector. 37% people belong to funds managed by geographical areas, 33% by substitute funds, 21% by their own employers funds (700 companies).

    Germany
    Financing continued. SICKNESS FUNDS In 2004, 14.23% of earning goes to sickness funds (46% by employers & 56% by employees). About 300 sickness funds in Germany No pre-existing exclusions or increased according to age or medical condition drugs, dental, preventive & maternity services. Mostly employees contribute 7% (same contribution by employers). rates

    Covered benefits are hospital & physician services,

    Germany
    Medical Care Strict separation of ambulatory care physicians and hospital based physicians (so poor coordination between the two as well) Hospital based physicians do not have private offices Ambulatory care physicians cannot work in hospitals 51% physicians are generalists (35% in USA) No referrals required from physicians to see specialists primary care

    Germany
    Payment to physicians & doctors Ambulatory physicians physicians association join the regional

    Sickness Funds pay a global sum each year to the association, which in turn pays physicians on the basis of detailed fee schedule Next quarter payment of physicians will decrease if services charged were high Salary of the hospital based physicians

    Germany
    Cost Controls (10.7% of GDP in year 2005) Govt. passed 1977 Cost Containment Act A body is created called Concerted Action, made up of health providers, sickness funds, employers, unions, government and different levels of

    Concerted Action is convened twice a year & every spring it sets guidelines for physician fees, hospital rates, prices of pharmaceuticals & other supplies Based on these guidelines, negotiations are conducted

    Thank You

    Thursday, August 04, 2011

    12

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