Astrid responded that the principle problems were excessive bureaucracy and poor management of limited finances. The primary reason for these problems, she wrote, is that for every one paying member of the "regulated" insurance, there are four people who pay nothing (children, retirees, and the unemployed). As a result, not every possible treatment is paid for, and many treatments or medications have to be paid for out of pocket because more expensive treatments, like for cancer, are paid for entirely by the system. [The only person I know to whom this has happened has a chronic illness and wants to take an experimental drug.] Astrid pointed out that because everyone in the private health insurance system is a paying member, those insurers can pay for nearly every treatment. Moreover, doctors are more and more tightly regulated by the insurance companies as to limit waste. This regulation, naturally, creates paperwork.
Annette, who spends most of her time teaching doctors cost-saving practices, gave a much longer answer to explain the same problem of "too little money in the system." I've translated her answers below, because many of Germany's problems seem to be exactly the same as ours.
The biggest problem of the regulated health insurance is that financial resources are becoming more and more limited. What are the principle causes?
1) People are getting older and older, and the morality rate increases considerably with age, which brings higher expenses in terms of health care with it.
2) More and more people suffer from chronic diseases like heart disease and diabetes, for example. This also increases health care expenses.
3) Thanks to new research there are always new medications, some of which are quite expensive. I'm thinking here of chemotherapy drugs, above all. In the meantime it has been legally established that not every price may be set when a new drug is launched. The legislation, however, was formulated so cautiously that new drugs often come on the market in Germany at prices that are much too high, even when considering the cost of research. A classic example is the Gardasil immunization against cervical cancer, which was introduced at considerably lower prices abroad.
4) Some expensive medications were more widely approved (for example, monoclonal antibodies) and have been prescribed more and more often, despite their cost.
5) Last year, considerable savings were achieved by the health insurance plans' renegotiation of certain contracts related to prescription drugs. Nevertheless, prescription drug expenses rose in general. Quantitatively more prescriptions were written and the overpriced drug launches I just mentioned made a significant difference in the budget.
From a macroeconomic perspective: The health care market in the Federal Republic of Germany is subject to powerful government regulation. Supply and demand do not determine prices. Contrary to market forces, the state intervenes in price formation in favor of the health care providers. The services of hospitals, doctor's offices, and rehabilitation clinics are subject to "set prices." For prescription drugs, the range of prices and distribution channels are regulated quite exactly. The health care system is financed by wage-dependent premiums that are independent from the use of care. The system is threatened by a spiral of increasing premiums, increasing costs of employment, decreasing employment and decreasing insurance income, which in turn pushes the premiums upward and limits the usable income of the insured.
Annette's concern here, in other words, is that rising health care costs (created mostly by an
aging population) will decrease the ability of Germany to employ all of its people, and in turn, make health care more expensive because fewer people are employed. This is the danger that almost all of Europe'and Japan currently face.The United States faces the exact same problem without any of the benefits of universal coverage. Americans are routinely trapped in bad jobs because they fear losing their insurance. Americans routinely infect their fellow employees, thus decreasing efficiency, because they can't afford basic health care or taking days off. People die every day in the USA because they haven't had preventative care. Hospitals, like Grady in Atlanta, are frequently threatened with bankruptcy because their emergency rooms are flooded with uninsured patients.
It is absurd that the richest nation in the world refuses to provide such a basic service for its citizens.
