Organizational Systems and Quality Leadership

Nicole Houchin

July 26, 2019

Western Governors University

I will be providing a comparison of the United States Healthcare System to that of the German Healthcare system.

Germans residents have access to free public healthcare, which means medically necessary. Social security contributions fund the medically essential healthcare. Citizens are required to have state or private health insurance. To include procedures such as immunizations, prescriptions, and dental checks. All salaried workers in Germany have to have public health insurance, are not allowed private insurance. And if you are eligible for private insurance, you can choose one or the other, but you cannot have both. (German Insurance: Costs &Coverage, 2019)

In the US, public health care is offered, but individuals need to meet a particular set of criteria to receive free public healthcare. Medicaid is government-financed insurance that assists many whose household income falls under a certain level to be covered by Medicaid. Similar to social medicine in Germany where if an individual is employed, the family is covered as long as their income falls below a level. You make more; you pay more. (Healthcare in Germany, 2015) Those who are over the age of 65 or who have disabilities can be covered under Medicare. Medicare is a program offered in the US as a federally funded healthcare system. Children are either covered under their parents plan until the age of 26 if needed, and there are also government programs such as the Children’s Health Insurance Program (CHIP) to provide health coverage through Medicaid and other programs. These are funded jointly by state and federal government. (CHIP, 2019)

When an individual is unemployed in the US, they may not be eligible to receive government assistance. Unlike coverage in the US, when a person in Germany becomes unemployed, they may receive transient coverage until employed again or otherwise directed.

In the US upon retirement at the age of 65, you will become eligible for Medicare, which will cover a lot of your medical expenses, but not all. You will be able to get private Medigap coverage to shorten the gap between those expenses. If unable to afford and upon further stipulations in regards to income, you may still qualify for Medicaid services also.

Germany has a social security system and statutory pension insurance: contributory, noncontributory social compensation program, and social welfare program. The contributory plan protects those who pay into them. The noncontributory social compensation program provides a program for those in the military or public service — the social welfare program aid to those who are not eligible under the other two programs. (Healthcare in Germany, 2015)

In regards to medication coverage for the US and Germany, the medications are costly for both when health insurance is not in the picture. The US and Germany have a system in place cost-effective medication alternatives in many cases. There are cost effective medications for many diseases, but there are many very expensive medications to treat a variety of illness that are costly even with adequate coverage. In the US, many use lower cost alternatives or generic to keep costs lower, or choose to forego the medication due to cost. In Germany, in accordance with the many new drugs on the market, the more expensive medications have to prove they are actually better than the older counterpart, and if you choose to use the more expensive medication you will be responsible for the cost. (Khazan, 2014)

In the US, referrals to specialists are based upon the individual plan’s requirements. Some don’t require a referral, and others do. In Germany, the social plans must receive a referral from their PCP; whereas, private insurers may allow participants to choose any physician of their choosing. (Healthcare in Germany, 2015)

In the US, coverage for pre-existing conditions, according to the Affordable Care Act, can not infringe upon one’s right to access healthcare. In Germany, pre-existing conditions are waived with universal coverage. Private plans can deny coverage and charge higher premiums for elective treatments and accommodations.

In Germany, the financial implications are more taxes to fund the social sickness funds. They are told that it is a duty to take care of one another, but many would argue that more taxes will cause hardship on families already expected to pay a high rate of taxes. Similar is the US, a penalty is charged for those who choose to forego health insurance. If you do not qualify for government assistance and are employed, you may not be able to afford health coverage.

References (ASPA), H. S. (2017, January 31). Retrieved from Pre-existing Conditions: CHIP. (2019, 26 July). Retrieved from German Insurance: Costs &Coverage. (2019, July 5). Retrieved from Healthcare in Germany. (2015, May 6). Retrieved from Khazan, O. (2014). Why Medicine is Cheaper in Germany. The Atlantic.