National health insurance in Germany

							                   National health insurance in Germany
                  Do we need the government as a partner?
                       Eckhardt Boehle – General Secretary
                    Deutscher Verband fuer Physiotherapie (ZVK)

Purpose:
National health insurance is available for all citizens regardless of income, social
status or place of residence. The pillars of our health service are solidarity and
subsidiary. One feature of the subsidiary principle is self-administration. This is not a
state-operated health service it is moreover an independent co-operation between
health insurance providers, medical professions, hospitals and professional
organisations. The state’s task is to create the necessary organisational service
framework for all co-operating partners.
90% of Germans have national health insurance. The remaining 10% have private
medical insurance. The most outstanding characteristic of both national health
insurance and private health insurance is solidarity-based financing. The principle of
solidarity-based financing is as follows: those who earn less, pay less. Services are
mainly available in the form of benefits. Patients are able to take advantage of health
insurance benefits without having to pay for these directly. The party providing these
services, such as physiotherapists, receive payment directly from the national health
insurance provider.
Relevance:
Out-patient healthcare for patients is primarily carried out by private practioners.
There are approximately 18,000 registered physiotherapists as private practioners in
Germany, registered to treat members of the national health insurance.
The services carried out by physiotherapists and charged to the national health
insurance providers are contained in the so-called cure and medicine guidelines. The
professional association must be involved in the drafting of these guidelines.
The social welfare law governs the prerequisites of private practioners. With regards
to the services provided the remuneration of these services and the settlement
thereof, the national health insurance providers sign agreements with the
professional association.
In accordance of the social welfare law, the leading organisations of the national
health insurance providers as well as the professional association have to sign joint
general agreements for the uniform provision of these services. In particular, these
agreements govern:
1. The contents of the individual cures and medicines including general scope and
   frequency of the treatments and the general treatment period;
2. The quality assurance measures comprising the quality of treatment, the
   treatment procedures and the results of the treatment;
3. The contents and scope of the co-operation between the physiotherapist and
   other health care professions;
4. The efficiency measures for the provision of services and the controlling thereof;
5. The remuneration agreements.
Conclusion:
In addition to the valid general agreements and within the context of self-
administration, the professional association is, through the agreements, involved in
ensuring the provision of physiotherapy services within the health service. For the
association, this is a considerable contributing factor towards ensuring proper service
provision for national health insurance members.
In the context of self-administration, remuneration lists are compiled on the basis of
the cure and medicine guidelines and the service description. Remuneration
negotiations are held between the professional association and the leading
organisations of the national health insurance providers. What is decisive is that
these remuneration negotiations are – within the context of self-administration –
conducted by the professional association and are not fixed in price by the
government.
National health insurance in Germany is an extremely important component of our
national insurance program and as such is not left to the forces of the market
economy. Based on this principle, all patients have the right to equal provision of
services, a fact that distinguishes national health insurance in Germany. And the fact
that – through their professional association – the professionals are able to exert a
corresponding influence as a result of their know-how must be viewed in an
extremely positive light.
Based on the principle of self-administration partners of the professional association
are the health insurance providers. The task of the government is merely to ensure
the basic conditions through the social welfare law.