The German Health System

This article provides an overview of the German healthcare system, including the standard of health in the country. It discusses the healthcare standards, efficiency, and access to healthcare in Germany. The article also explores the similarities and differences between the healthcare systems of Germany and Australia.

Running head: NURSING ASSIGNMENT
THE GERMAN HEALTH SYSTEM

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The Standard of health in Germany
As per the German Government Healthcare system, the public healthcare system is
the primary pillar of healthcare and depending on it the other healthcare system namely the
private healthcare organisations, insurance, and legislation system is developed (The
Commonwealth Fund, 2019). The states whereas vary among themselves depending on their
subgroups and population of the process. While discussing the demographics of the
healthcare system of Germany, the total population of Germany in 2019 has been recorded as
82,421,954 within which 20.8% people were above the age of 65, hence required effective
and immediate healthcare service for the healthcare concerns (Health in Germany, 2019). It
was also seen that the number of smokers was 21% and 16% were suffering from the
prevalence of obesity.
Within 16 states of Germany, after implementation of Preventive Health Care Act in
Germany, only two states North Rhine – Westphalia and Bavaria have achieved maximum
immunisation with 89.5% and 71.4% respectively (Health in Germany, 2019). Further, it
should also be mentioned that these two states have high rate of GDP in German states and
has every facility for conducting effective health care. Further, the child mortality rate in
North Rhine – Westphalia is 3.34% per 1000 person and 2.28 in Bavaria (Health in Germany,
2019). Moreover, the report also mentioned that in North Rhine – Westphalia, more than 89%
people avail health insurance on the other hand Germany has 59% of total health insurance
coverage (Health in Germany, 2019). Due to this, the government spent $5119 for the
healthcare spending of per capita population in Germany.
Hence, from these detailed description of healthcare in Germany, it could be said that:
1. Obesity, geriatric care and improper distribution of funds were one of the primary
concerns of the German health ministry.

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2. Socio-economic status, social determinants of health and wealth of the service
users play an important role in the attainment of healthcare in Germany.
3. Despite the fact that Germany spends 11.1% of its GDP in healthcare and 4% in
the health promotional activities, attainment of healthcare is lower in the country
due to the higher number of geriatric patients seeking for palliative care.
Standard of healthcare
As per the Jackson and Barber (2015), the healthcare system distribution, delivery and
finance of the healthcare system is divided into several sections such as physicians,
administrative mechanism for the direct patient payment providers, after hour care system,
hospitals, mental healthcare system and palliative or long term care with social and cultural
support. The healthcare system in Germany is inclusive of Ministry of health and states as the
primary and highest in the hierarchy. In this, while the ministry of health involves in the
inpatient and outpatient healthcare, states are involved in public health agencies. The third
independent aspect of the healthcare system in Germany is its healthcare insurance system
and as per Memon et al. (2017), this operates both in public and private domain so that
effective care could be provided to the patients.

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Hence, after analysing the standards of healthcare in Germany, it could be said that
 The reformed healthcare standards are developed so that the lower and
backward section of the society could be provided with effective healthcare
interventions.
 The government also aims to develop a universal healthcare system through
merging the public and private healthcare services for the growth and
improvement of the healthcare facilities.
Joint commitsion international
1. anaesthsia and surgical care
2. patient and their family education
medical professional education
3. research programs depending on
human subjects and assessing the
patients
Health standards in Germany
1. Administrative mechanism
2. Direct payment methods for
patients
3. palliative or long term care with
social and cultural support
Health standards of Australia
1. Clinical Governance and Medication
Safety
2. Partnering with Consumers and
Comprehensive Care
3. Preventing and Controlling Healthcare-
Associated Infection with comprehensive
Care
4. Communicating for Safety and blood
Management,
5. Recognising and Responding to Acute
Deterioration.
Insurance and
medication
safety
Governance
Figure mentions the healthcare standards of Germany, Australia and the international healthcare
standards mentioning the similarities and differences (Developed by the author) (Joint Commission
International, 2019), (Australian Commission on Safety and Quality in Healthcare, 2019)

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Ranking of Germany as per healthcare:
https://www.internationalinsurance.com/health/systems/
Ranking as per the GDP of the country: https://www.who.int/countries/deu/en/
Similarities
As per the World Health Organisation (2019), the healthcare standards in Germany is
regulated through several steps such as regulation and governance of third-party payers,
regulation and governance of service providers for maintaining quality and safety, process
related to planning and registration of human resources, and the regulation of pharmaceutical
products. In the major reform in 1990, the German healthcare system developed several
legislations and regulations that led the service to be extended for the lower and backward
section of the society including patients that are unable to obtain healthcare interventions due
to their financial and social conditions. As per The WHO (2019), the standards include the
standards for Health Promotion in Healthcare, standards for service providers and quality of
care, quality management guidelines and occupational and multidisciplinary healthcare
system, and standards for the healthcare workers for their growth and development as
healthcare service users (World Health Organisation, 2019). These are the international
standards and it is important for all the healthcare facilities around the world to comply with
such standards so that the quality and safety of healthcare service users could be determined.
Besides this as per The Commonwealth Fund (2019), the standards for healthcare in Germany
aimed to prevent diseases and promote health promotion, developing emergency and rescue
care, developing self- help groups by increasing the patient information, and increasing the
chances of rehabilitative care, psychotherapy (World Health Organisation, 2019).

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Differences
The only healthcare standard which is common in between Germany and Australia is
presence of healthcare promotional and preventive plans and both the government spends a
specific amount of money in these aspects for the growth and development of healthcare
system. However, this is also one of the differences that both of these countries government
shares. As per Australian Institute of Health and Welfare (2019), Australian government
spends 10% of its GDP in healthcare promotion, on the other hand, despite having modern
healthcare strategies, the German government spends only 4% of its GDP in healthcare
promotional programs and hence creates a gap in the process. besides this, multiple studies
has highlighted to the rigorous consequence of improper and poorly developed health
governance structures in German international healthcare system, that completely could
destroy the unities, independent and quality of the completely developed processes (Osborn
et al., 2015, Heymann et al., 2015). From these selected literature articles it could be
understood that local and central government policies should be developed establish
depending on the roles and responsibilities, as well as effective agreements between the
actual stakeholders of the healthcare system and effectively impose sanctions on the available
resource so that proper allocation of healthcare services among the states of Germany could
be achieved.
Conceptual framework of Efficiency
Philosophical significance of Efficiency
The primary aim of this section is to describe the performance of Germany in meeting
one the goal of international healthcare system so that maximum benefit could be provided to
the public of the country. The philosophy related to efficiency in healthcare deals with the
study of ethics, maintenance of the healthcare system, connection between the healthcare

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means and the people so that the care could be effective and with higher efficiency, each of
the concern of the patients could be addressed. In this aspect, it should be mentioned that
equity deals with the satisfaction level of the health professionals and the way they deal with
patient complications. On the other hand, efficiency related framework mentions about the
complete utilisation of the healthcare facilities and interventions by the population, hence this
conceptual framework would be effective in determining an effective insight of the healthcare
system in Germany.
What is efficiency?
With application of efficiency, it is easier to mention that all the healthcare aspects
provided by the government is utilised by the population of the country or not. Hence, with
analysis of the healthcare efficiency, it would be easier to analyse the effectiveness of the
policies nd strategies of the nation. Hence efficiency based framework has been used in this
section.

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Efficiency framework
The criteria for maintaining efficiency in the healthcare are as follows:
1. Governance
2. Increasing the quality of healthcare
3. Increasing access
4. Maintaining the administrative cost
Conceptual framework for efficiency in healthcare (Hans, Van Houdenhoven & Hulshof, 2012)

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This following analysis would be discussing the German healthcare system and its
efficiency that has been developed after the complete reform of the German healthcare
system.
Increased access to healthcare
As per the conceptual framework of efficiency, there are several key characteristics of
the healthcare service delivery in the healthcare system in Germany and these are
accessibility, coordinative, person-centered, comprehensiveness, coverage, continuity,
quality, and accountability. As per Uneke et al. (2014), it is important for any healthcare
system to be inclusive of all these aspects so that the healthcare system could include a
fundamental input to develop public healthcare system (Hans, Van Houdenhoven & Hulshof,
2012). Hence, for the understanding of good functionality of any healthcare system, these
aspects should be identified. The acts such as the Healthcare Reform Act and SHI Reform
Act 2000 and SHI Modernization Act of 2004 mandates the including of hygiene and safety
equipment in the healthcare facilities and through this, it made the healthcare facilities,
accountable, and increased its coverage by increasing the inpatient and ambulatory care
providers (Uneke et al., 2014). Further, for the quality assurance of the healthcare sector, in
the year 2007, the German government mandates the including of quality assurance measures
by implementing the regulations provided by the Federal Joint Committee (Hans, Van
Houdenhoven & Hulshof, 2012).
Increasing the quality of healthcare
As per the conceptual framework mentioned in the Hans, Van Houdenhoven and
Hulshof (2012), the healthcare workforce is a group of people working in public and private
sector healthcare organisation and work in different domains so that a collective and holistic
care could be provided to the service users (Hans, Van Houdenhoven & Hulshof, 2012). In
this aspect of building block, the system mandates that these population should be provided

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with abilities so that they could overcome their concerns and provide effective care to the
patients, further it also mentioned about providing such professionals with educational and
training aspects so that it could increase their abilities as healthcare professionals (Kutzin,
2013). The Health Care Structure Act of 1992 and it mentioned that the nursing professionals
should not be involved in care process more than 215 minutes as it may affect their duties as
a nursing professional (Kutzin, 2013). Further, it also developed facilities for licensing for
pharmaceutical development that increases the accuracy of the care process.
Governance
As per this aspect of the efficiency conceptual framework, it is important to have a
strong and reliable leadership so that financing, quality assurance, and development related
crucial factors could be accurately mentioned. It mentioned that the majority of the healthcare
facilities in Germany several governance-related decisions has been taken so that
transparency in the care process could be achieved (Ghaffar et al., 2016). While developing
the care intervention, the healthcare professionals should be provided with effective
knowledge about the patient and hence healthcare information system becomes mandatory.
As per Mounier-Jack et al. (2014), application of reliable, comparative data, understandable,
authoritative and usable data should be done in the healthcare information system. In the
healthcare system of Germany, German Hospital Federation, German Nursing Council,
developed a Federal Joint Committee so that they could implement the healthcare information
system in the healthcare facilities and in the process in 2007, implementation of the Act to
Strengthen Competition in SHI helped to understand the important of informatics and
implementation of 206 quality indicators to understand the importance of it in the healthcare
system. Hence, this aspect of conceptual framework for efficiency was achieved (World
Health Organisation, 2019).

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Increasing quality of healthcare
This conceptual framework of efficiency discusses the national policies and
guidelines that help to regulate the type of healthcare medication developed for the benefit of
people and the international law discusses the procurement, storage, and supply of the
pharmaceutical products that are being manufactured by reliable resources to maintain patient
safety and training. Similar regulation has been developed by the German government as the
Pharmaceutical Act (Arzneimittelgesetz) of 1976 that helps to regulate the procurement,
storage and supply and production of medicines in the pharmaceutical manufacturing units in
Germany (Hentschker & Mennicken, 2015). Hence this aspect of international standard is
achieved by the German healthcare facilities.
Maintaining the administrative cost
The financing of healthcare system mentioned by the conceptual framework for
efficiency discusses about the aspects such as governmental and non-governmental funding,
financial risk protection, funding for the healthcare professionals training and development
and others that should be present in the healthcare facilities so that effective and accurate care
could be achieved (Hentschker & Mennicken, 2015). The German Government includes the
regulation for capital investment and within this, the Hospital Financing Act 1972, The
Hospital Financing Reform Act of 2009, and others are implemented so that structures and
transparent financing system for healthcare facilities could be developed and implemented in
the care process (Memon et al., 2014).

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