Assessment of health system performance in Germany: Survey‐based insights into the perspective of people with private health insurance

Abstract

Introduction The World Health Organization (WHO) defined intermediate and overall goals to assess the performance of health systems. As the population perspective becomes more important for improving health systems, the aim of this study was to gain insights into the perspective of people with private health insurance (PHI) in Germany along the predefined WHO goals. Methods A cross‐sectional survey was conducted in 2018 among people with PHI in Germany. The questionnaire included items on all intermediate (access, coverage, quality, and safety) and overall WHO goals (improved health, responsiveness, social and financial risk protection, and improved efficiency). Descriptive analyses were conducted for the total sample and subgroups (gender, age, income, and health status). Results In total, 3601 respondents (age 58.5 ± 14.6; 64.7% male) assessed the German health system. For example, 3.3%–7.5% of the respondents with subjective needs reported forgone care in the past 12 months due to waiting time, distance, or financial reasons and 14.4% suspected medical errors in their care. During the last physician visit 94.2% experienced respectful treatment but only 60.6% perceived coordination of care as good. Unnecessary health services were perceived by 24.2%. For many items significant subgroup differences were found, particularly for age groups (18–64 vs. 65+). Conclusion Conducting a health system performance assessment from the population perspective gained new and unique insights into the perception of people with PHI in Germany. Areas to improve the health system were seen in, for example, coordination of care, financial risk protection, and quality of care, and inequalities between subgroups were identified.

Health Literacy of People with Substitutive Private Health Insurance in Germany and Their Assessment of the Health System Performance According to Health Literacy Levels: Results from a Survey

“…Between October and December 2018, 20,000 people with substitutive private health insurance from ‘Debeka’ were invited to participate in a quantitative cross-sectional survey [ 26 , 27 ]. The study was approved by the Ethics Committee of the Charité – Universitätsmedizin Berlin (EA4/075/18).…”

“…Therefore, we conducted a comprehensive HSPA from their perspective along the WHO’s goals (project IPHA “Integrating the Population Perspective in Health System Performance Assessment”, see [ 26 ]). This revealed insights into the overall health system performance from the PHI insureds’ perspective, and further uncovered performance variations and inequities between sociodemographic subgroups (e.g., regarding age, gender, income, health status) [ 27 ]. As the performance was not homogenously perceived by this specific population group, it was further assumed that other patient characteristics, such as health literacy levels, might also uncover inequities.…”