An Overview of the Health Care Reform -- MEDICA - World Forum for Medicine

An Overview of the Health Care Reform

Photo: Insurance card in Germany

Since 1 January a health insurance
is obligatory for all citizens;
© Claudia Hautumm/

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 That is the reason why the seven head organisations of the state insurance has been replaced by one head organisation on 1 July 2008.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.

Simone Heimann