Health Care Diagnosis: Poor to Critical

Health care in Germany is ailing. It hasn’t entered intensive care just yet, but if something isn’t done to reform this system that was long touted as one of the best in the world, the life support machines might have to be brought in.

The problem is partially one the system has created for itself – advances in medical care mean people are living longer. At the same time, changing priorities means people are having fewer children.

That demographic change is a recipe for disaster for a medical system structured as Germany’s is. It depends on younger people paying into a system and financing medical care for the society’s older members.

As medical knowledge has advanced, treatment has become more expensive. Health care costs have reached a new high, and they show no sign of slowing down. While Germany spent €29 billion ($26.4 billion) a year on health care in 1976, today that number is up to €250 billion ($216 billion) and rising.

That means employees are having to pay more and more into the country’s health system. For the first time, employee contributions went above 14 percent of gross income.

Low Public Confidence

All this while patients watch services deteriorate. Health plans are refusing to pay for more non-essential procedures. Hospitals and clinics are being forced to close. Twenty-four percent of the total population say their physicians have begun to refuse to prescribe medicines they did in the past. Most believe that Germany’s statutory health plans will be cut so drastically that in ten years they will only cover the most basic types of care.

Any discussion of the health care situation in Germany generally follows these gloomy lines. Recent surveys have shown people expect to see the decline in health care quality in Germany to continue. The percentage of those rating Germany’s health care system as either good or very good fallen from 82 to 61 since mid 1990s.

Enacting Reform

A large majority of the populace say there will have to be some kind of reform to the system if it is to survive.

But what to do?

The government doesn’t seem to have many good ideas, or the political will to make good on its talk of reform. Germany’s health minister Ulla Schmidt (photo) has said she wants to "fine-tune" the existing system rather than radically change it.

At the end of 2001 one, her ministry hastily drew up "drugs savings plans" to encourage the use of generic drugs. No one really outside her staff takes them seriously and most say it was just a face-saving measure to show that she was at least doing something.

Now that it is an election year, Schmidt has publicly said any more reform will have to wait until after elections on September 22nd.

Opposition politicians haven’t been that much more forthcoming or concrete with their proposals. The conservative Christian Democratic Union and the Christian Social Union as well as the Free Democratic Party have made noises about health funds which would offer a greater range of premium options in exchange for less coverage.

The ruling Social Democrats see that as non-egalitarian and say it would put Germany on the road toward a two-tiered system, where the wealthy can "buy health" and everyone else has to put up with a steady deterioration in the care they get from state-funded schemes.

Maybe they should read the polls. 70 percent of Germans already think that’s the shape of things to come.