The New German Healthcare Reforms/ 2009

I've found these very interesting.. And I see so many ideas we shoudl be using and do need (IMO) in the US.





Aside from some major changes in their Universal Care, they have recently
addressed, in their private healthcare insurance system many things that I believe we need to address in ours in the USA, as well.
I've marked those in red.


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(From Medica.de)
Germany: An Overview of the Health Care Reform

Long
before the introduction on 1 January 2009, a great many critical voices
occurred in regard of the German health fund which is the principal
item of the health care reform that came into effect in 2007. The
consequences the reform has for insured people and which areas of the
whole reform package is already valid – an overview.


A broken leg after skiing or a life saving heart transplantation –
medical care costs a lot. So much that people without health insurance
can hardly afford it. Therefore, Germany's government decided in the
course of the health care reform on an obligatory insurance for all
citizens in order to assure medical treatment for all that is being
paid for by insurances. People that need to be insured by compulsory
health insurance like employees have to follow this part of the reform
since 1 April 2007, those with a private health insurance like
self-employed and civil servants since 1st January 2009. However, other
changes applying to health insured Germans since 2007 are that health
insurances have to pay more rehabilitation measures and many
vaccinations. Also, the ambulatory treatment in hospitals receives more
attention.

A unitary contribution for more competition


The government hopes that changes in the insurance structure causes
more transparency. That is the reason why the seven head organisations
of the state insurance has been replaced by one head organisation on 1
July 2008. Also the financing of compulsory health insurance completely
changes with the introduction of the health fund. Since 1 January 2009
those insured by state do not pay their contribution to their insurance
but to a common fund with a unitary contribution of 15,5 percent. The
German Federal Ministry of Health wants insurances to compete more
since this gets the citizens to pay more attention to the services and
not to an insurance fee. Furthermore, insurance companies that work
more efficiently can pay back money to their customers, those not
working efficiently need to demand additional fees.


New is also the mechanism how the money in the health fund is
distributed. It depends on the diseases of the clients how much money
the insurance receives from the fund. The criteria so far had only
considered gender and age, now a list containing 80 diseases such as
AIDS, several forms of cancer, dementia, epilepsy or stroke serves as
the basis. The Federal Ministry of Health's intention was that the
insurance companies can better plan care for their patients this way.

New basic rate for privately-insured patients


Finally, the private insurances are also subject to reform. Since 1
January 2009 a new basic rate exists which must be comparable with the
basic rates of the compulsory health insurance. This basic rate applies
to everybody and the private insurance companies can not anymore refuse
people due to age or disease.

And this just blows me away---

Just passed into use now is a new scheme for Health insurance Funding called the Morbidity Oriented Risk Structure Compensation Scheme. Morbiditätsorientierten Risikostrukturausgleich, or short: Morbi-RSA

Here's an interview about it. It is genious, in my opinion.

MEDICA.de: Through the morbidity oriented risk structure
compensation scheme (Morbiditätsorientierten Risikostrukturausgleich,
or short: Morbi-RSA), insurancies receive more money for insured with
certain illnesses than for others. Why is the Morbi-RSA thus important
for you?


Barske: For the many seriously ill insured it is important
that their insurancies have the necessary resources to provide for good
medical treatment. With the Morbi-RSA, this will work out better. For
many seriously ill in the AOK or other statuory health insurancies this
is advantegous.


MEDICA.de: Primarily, widespread diseases as back pain should not be included in the Morbi-RSA. The AOK was in favour of it. Why?


Barske: If physicians have to do a lot to help ill people,
then this has to be affordable. It would be nonsense if money was
missing to pay physicians when they can help.

MEDICA.de: The insurancies have to budget economically to avoid
additional premiums. Will healthy persons be neglected - will
cost-intensive prevention schemes be cancelled?


Barske: Prevention is not only for healthy people. And for
example to help an overweight person to live healthier does not have to
be expensive. Prevention also means: averting that diabetic patients
lose their eyesight. With the Morbi-RSA, this will also be possible in
future.


MEDICA.de: Would you have preferred Morbi-RSA without health fund?


Barske: As the Stones sing: „You can’t always get what you want.”