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No equal access with Germany’s “universal” health care

Many people support government-controlled health care because they think it will provide everyone with equal access to medical treatment, regardless of their ability to pay. Ronald Bachman of the Georgia Public Policy Foundation recently visited Germany with other health care policy wonks from the U.S. to learn about the health care in Germany. He reports that:

We listened to federal and state officials, doctors, hospital executives, members of the Bundestag (German parliament, a health journalist and German policy experts. They told us that the German system is the fourth most expensive system in the world. Their costs are rising rapidly and are unsustainable. …

Solidarity is the mantra and the cornerstone, and was explained to mean the entire population participated in and was in agreement that everyone should have the same health care.

Yet, many people wait for treatment:

At each meeting it was reiterated that 90 percent of Germans have compulsory statutory social health insurance through one of 170 plans. Under most plans, there are waiting times for office visits, delays for elective hospital care and postponed care if quarterly medical budgets are exceeded. Choice of physicians/surgeons is limited and private hospital rooms are not available.

But not everyone has to wait:

Ten percent of Germans, generally wealthier, are covered by 50 private insurance plans. … These individuals get to the front of the line for appointments, have access to private hospital rooms and use of “master” surgeons and leading specialists.

At one meeting it was mentioned that private coverage was “complimentary to special systems of civil servants, judges and soldiers.” Civil servants are defined as federal government employees, state employees, professors and others. By some estimates, civil servants make up about 14 percent of the German workforce. When pressed for an estimate of civil servants in the private insurance option, the German experts stated that 80 percent of those in the private health option are civil servants, with most of their premiums paid by their government employers.

Which raises two questions: If 80 percent of the private plan participants are government employees getting better access to better care with the best providers, how is that solidarity?

There’s also rationing through global budgets:

It seems that even primary care physicians operate with more than 100 separate quarterly budgets covering office visits, exams, laboratory tests, prescriptions, referrals, admissions and more. When the budget runs out, services can be performed but the physicians will not get reimbursed. Many patients must wait until a new quarterly budget is established for the service. Patients are never told they may be waiting because of a “maxed out” budget. Apparently, near the end of each quarter many primary care physicians close their offices after meeting their key budget limits.

Doctors at one meeting said a single quarterly co-payment of 10 euros ensures unlimited access to primary care physicians. Germans say they need thousands of new primary care physicians. The average number of visits to primary care providers in Germany is about 18 per year, compared with the U.S. average of about three. …

I asked, “Do consumers know if the delay of a cancer test is because of a budget limit? Can they find information to go to another physician who has not hit his budget limit for that test?” The answers were “No” and “No.” Citizens are not told the reason for any delays, have no access to information on physicians’ budgets and, of course, most have no idea budget limits exist.

Hospital officials talked about the high quality of surgeries and specialist care. The data showed few complications, low infection rates and high survival rates. I asked, “Do patients have access to the quality information to compare hospitals and physicians?” The response was, “It is available to data experts but could never be understood by the average German.”

Bachman concludes:

At the end of the day, German consumers seem to be pawns in a great game of controlling costs through budgets, restrictive choices and limited access to care….

Consumer interests in social health systems seem to fall behind government employees, unionized physicians, bureaucratic budgeting, Big Pharma and political interests.

Soon we’ll find this in the United States, unless citizens vote for politicians who support a free-market in health care and insurance.  Read the whole article: A Case Study in How Consumerism Loses in European-Style Health Care.

(via StateHouseCall)