Germany’s health system brings ‘a-ha moments’

As Julie Brunner learned more about Germany’s health-care system, she couldn’t help but think about the reform debate raging back home.

“Here we were in Berlin and nobody was fighting about who should be covered,” said Brunner, executive director of the Minnesota Council on Health Plans. “They cover everyone and they don’t fight about it.”

Brunner was one of a seven-member delegation from Minnesota who visited Germany about a month ago as part of a series of trans-Atlantic dialogues on health care between the state and that nation. Last spring, Germans came here for a conference hosted by the Center for German & European Studies (CGES) at the University of Minnesota.

On Wednesday night, about 80 people heard Brunner and other members of the Minnesota delegation discuss their “a-ha moments” at a CGES salon on “Smart Health Care: Looking at Germany from an American Perspective.”

A social ethic of solidarity
Moderator Steven Schondelmeyer, a U professor of pharmaceutical economics, said Germany’s health-care system is based on the social ethic of solidarity. While Americans might associate the term solidarity with the Polish uprising led by unionist Lech Walesa, he said, the concept basically means that everyone deserves health care no matter their financial circumstances. (Princeton professor Uwe Reinhardt gives a detailed explanation in the New York Times Economix blog.)

Germans finance their health system with a 7 percent tax on employee wages and a matching 7 percent tax on employers, and the government covers care for the indigent. Medical school is funded by the state, which means no doctor leaves school with the six-figure debt common in the United States, and as a result Germany doesn’t have a shortage of primary-care physicians as the United States, panelists said.

State Sen. Linda Berglin, DFL-Minneapolis, said her “a-ha moment” came while looking at comparisons of per-person spending for the United States and Germany. “They don’t have any medical debt,” said Berglin, who is chair of the Senate Health and Human Services Budget Division. She started wondering, “What is medical debt worth?”
“The way we pay is skewing us toward more expensive care,” she said. “Most of us know we need more primary care physicians,” but the lower salaries and medical-school debt drive doctors to high-paying specialties. “To me, when you look at the numbers comparing per-person cost, it isn’t the whole picture. We need to insert into the conversation the medical debt we pay.”

A ‘doctor-centric’ system
Cal Ludeman, Minnesota’s commissioner of human services, said he was struck by the “doctor-centric” German system and two statistical averages that would be unheard of in the United States these days: 18 office visits per patient per year and 15-day stays in hospitals.

Ludeman, who oversees the state’s government-supported programs like Medicaid, said he was interested in who decides how health-care dollars are spent each year in Germany. “The flow of dollars goes to the doctors association. … In America, it’s complicated. … They say, ‘Here you go, doctors — you figure out how it’s distributed.’ ”

“They are used to a universal coverage environment,” he also noted. “You don’t hear a lot about cost-shifting.”  

Connie Perpich, a lobbyist for Planned Parenthood of Minnesota and the Dakotas, said she felt “profound amazement” by the concept of “we all take care of one another.”

Perpich, who once worked as a nurse’s aide in Germany a few decades ago, said she also was surprised that nurses still aren’t an important part of the health-care system as they are here. “We heavily utilize nurse practitioners,” she said, adding that German nurses go through a three-year technical school vs. the typical four-year education here.

Family planning integrated into basic program
Another noteworthy difference for Perpich, whose organization has encountered a lot of backlash over reproductive health: “There are no family planning clinics in Germany — the services are all integrated into the basic German program.”

Brunner, whose organization represents insurance plans in Minnesota, said the German approach to the pharmaceutical industry was impressive. “[The system says,] ‘This is what we’re going to pay you and if you don’t like it, you don’t get to sell drugs in Germany.’ … If you look at the cost of drugs in Germany and here, it’s stunning.”

Berglin thought Germany’s system of “evaluating new drugs that come into the market from a cost-benefit standpoint” might work here. “They look at the value added and what is its worth.”  

So, what do Germans find interesting about Minnesota’s health-care system?

“Germans … are really interested in the Mayo system” of team-oriented care as well as Minnesota’s use of electronic records, Brunner said. “Our health information technology is so much more mature.”

Related content:

Minnesota-Germany ‘connection’ providing healthy exchange of ideas
by Ann Alquist | June 16, 2008

• On Dec. 27 and 28, Minnesota’s tpt station will air “Smart Healthcare: Looking at Germany,” a program about the recent visit.

• Videos of previous health-care conferences can be seen here.

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Comments (6)

  1. Submitted by Gregory Stricherz on 11/05/2009 - 12:04 pm.

    How does this statement about the US healthcare system

    Our health information technology is so much more mature.

    correlate with these statements?

    They don’t have any medical debt.
    The way we pay is skewing us toward more expensive care.
    Most of us know we need more primary care physicians.
    18 office visits per patient per year and 15-day stays in hospitals.
    You don’t hear a lot about cost-shifting.
    ‘This is what we’re going to pay you and if you don’t like it, you don’t get to sell drugs in Germany.’ … If you look at the cost of drugs in Germany and here, it’s stunning.”

    I think the statements about Germany are far preferable to a mature information technology healthcare system.

  2. Submitted by Bernice Vetsch on 11/05/2009 - 12:24 pm.

    In general, other countries have never given to the private insurance industry the power to control the health care system, which of course manages it in ways that enhance their profits rather than our health.

    In Norway, Switzerland and The Netherlands, all insurance is private but is regulated by the government the way we regulate private utilities to serve the common good. No person in these countries is without care or insurance, since government subsidizes premium costs for the poor.

    All insurers are non-profit entities; government determines the benefit set, provider payments, and drug and premium prices. The abuses to which Americans are subjected are forbidden.

    Couldn’t even the Blue Dogs embrace this or the German system as a solution? Any of them beat the Senate Finance Committee by a mile. Nay, a thousand miles.

  3. Submitted by Nancy Gertner on 11/05/2009 - 02:47 pm.

    Some of us Minnesotans have lived in Germany with an American perspective while wearing the uniforms of the United States Uniformed Services.

    Some of us found ourselves in German hospitals when we experienced medical emergencies like fracturing a bone in the Black Forest on Christmas Day.

    I don’t remember anyone in the German hospital asking me for an insurance card, or using that as a determinant if I would be treated or not.

    I do remember waiting a long time for my surgery because patients that were critically injured in auto accidents were treated first.

    I remember staying overnight in the German hospital, and being released the next day because my friend was taking me to the U.S. Military Hospital at Landstuhl. I remember receiving, and paying, a bill for about 1260 Deutschemarks. This was the equivalent of about 840 U.S. Dollars, and I was reimbursed by the U.S. government for this expense, since I was on active duty in the U.S. military, and the U.S. government was responsible for my health care. The DM1260 bill was all inclusive of hospital stay, surgery, attending physician, anesthesiologist, etc.

    So I understand why people travel abroad to have elective surgeries.

  4. Submitted by Michael Corcoran on 11/05/2009 - 06:40 pm.

    I love these field trips to other lands comparing US health care vs other countries. Did anyone take time to ask what the average German doctor’s income is? Would you be surprised to know it is the equivalent to $60,000 US? The average American doctor? $180,000.

    Would you now like to talk about why the US spends twice to three times as much as other developed countries for health care?

    Could a primary cause be labor costs?

  5. Submitted by Patricia Gundersen on 11/05/2009 - 08:46 pm.

    How many people went to Germany and who paid for it? Could they have used the telephone, or a video conference call?

    Here in Rochester,MN, we don’t have enough money to expand the jail so criminals just get fined, no jail time. We don’t have the money to hire more policemen, which we need. We don’t have the money to hire field personnel for Building Safety inspections to keep landlords in compliance. There are NO field personnel in Building Safety!

    Currently, the Mayor of Rochester is away on yet another trip to China to visit our sister city there :)) It seems to me that during these challenging fiscal times, it is more prudent to spend money on infrastructure rather than lame trips overseas that could be replaced by a telephone call.

  6. Submitted by Bernice Vetsch on 11/06/2009 - 10:52 am.

    Michael C: It’s not doctors’ salaries/incomes that make our health care cost twice as much as other countries spend per capita.

    It’s health insurance premiums sold by companies that (1) merged-merged-merged between 2001 and 2007 until 10 huge firms control almost all the U.S. market,(2) raised premium prices every year while denying claims AND refusing to insure people who they felt might get sick, AND watched their profits climb by 428% during those same years, and (4) used the lack of anti-trust legislation to allot most of the market in each state to about two companies.

    I find it amusing that opponents of health care reform say we would lose “competition” in the insurance industry — as if there were some!

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