Market Access in Germany

Abstract

Being initiated under Chancellor Bismarck in 1883, Germany's social statutory insurance is one of the earliest systems offering formal healthcare coverage for employed people as a part of a social security system. Since then, ever-changing environmental factors put continuous pressure on the functioning of the system: 1. the population grew to today approximately 82 million inhabitants, 2. scientific and medical progress has allowed the growth of an active healthcare industry, which today is an important pillar of the German economy, 3. better access to healthcare has increased longevity to a life expectancy at birth of 83.1 for women and 78.2 for men [1], 4. many otherwise deadly diseases can now be cured or controlled as chronic diseases, and 5. at the same time, the birth rate went down to currently about 1.5 children per woman (2015) [1] and therefore, a decreasing number of younger working people have to bear the increasing bill of total social security cost. Due to all these developments, healthcare expenditure has been continuously increasing to today about 11.3% of the German Gross Domestic Product (GDP) [2] and throughout the ongoing dynamics, the German healthcare system has experienced many revisions and changes over the years. Particular events were the split of Germany into two politically and economically strictly separated parts in 1949 and the reunification into the current Nation with the capital of Berlin in 1990. During these 50 years, the eastern part (about 1/3 of the territory; today 5 states plus Berlin) as "German Democratic Republic" was under the rule of the socialist Union of Soviet Socialist Republics (USSR) and the Western part (Federal Republic of Germany with 10 states) under temporary control of the 3 other victorious powers (USA, UK, France) favoring a democratic political system of social market economy. The reunification of the two healthcare systems after 1990 was driven by the social statutory insurance system established in the West. Figure 1 summarized facts and numbers about Germany.

Limiar de eficiência em avaliações de tecnologias em saúde

“…O restante, 9 milhões, é coberto por algum tipo de plano de saúde privado. A contribuição para o SHI gira em torno de 15,5% do salário do segurado e é dividida igualmente entre empregado e empregador (Holtorf et al, 2009). Neste modelo de sistema de saúde, pessoas com salários maiores dão suporte as que recebem menos, os mais jovens compensam os mais velhos, saudáveis os doentes e pessoas sem filhos as que possuem (Busse et al, 2017).…”