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Sick Around the World

Five capitalist democracies around the world - Japan, Taiwan, Switzerland, Great Britain, and Germany - all have health care systems that provide health care for everyone. They have higher life expectancies, lower infant mortality rates, and spend less money than the U.S. for health care. At any given time, at least 45 million Americans do not have health insurance. What lessons can the U.S. learn about health care from other countries?

In this video chapter from FRONTLINE Sick Around the World, travel to Germany with correspondent T.R. Reid and discuss the benefits of this country’s market-based health care system.

 

Discussion Questions

After watching the video about the German health care system, discuss your answers to the following questions:

  • What are the characteristics of the Bismarck model of health care used in Germany?

  • What role does competition play in the German health care system?

  • How is Germany’s health care system similar to the one in the U.S.? How is it different?

  • What are the strengths of Germany’s health care system? The weaknesses?

VIDEO SEGMENT BACKGROUND

  • How does Germany deliver healthcare to all its citizens?

  • Percentage of GDP spent on health care: 10.7

  • Average family premium: $750 per month; premiums are pegged to patients’ income.

  • Co-payments: 10 euros ($15) every three months; some patients, like pregnant women, are exempt.

  • What is it? Germany, like Japan, uses a social insurance model. In fact, Germany is the birthplace of social insurance, which dates back to Chancellor Otto von Bismarck. But unlike the Japanese, who get insurance from work or are assigned to a community fund, Germans are free to buy their insurance from one of more than 200 private, nonprofit “sickness funds.” As in Japan, the poor receive public assistance to pay their premiums.

  • How does it work? Sickness funds are nonprofit and cannot deny coverage based on preexisting conditions; they compete with each other for members, and fund managers are paid based on the size of their enrollments. Like Japan, Germany is a single-payment system, but instead of the government negotiating the prices, the sickness funds bargain with doctors as a group. Germans can go straight to a specialist without first seeing a gatekeeper doctor, but they may pay a higher co-pay if they do.

  • What are the concerns? The single-payment system leaves some German doctors feeling underpaid. A family doctor in Germany makes about two-thirds as much as he or she would in America. (Then again, German doctors pay much less for malpractice insurance, and many attend medical school for free.) Germany also lets the richest 10 percent opt out of the sickness funds in favor of U.S.-style for-profit insurance. These patients are generally seen more quickly by doctors, because the for-profit insurers pay doctors more than the sickness funds.

Go Further

Featured Lesson Plan: “An Urgent Choice For The United States: How To Reform Health Care”

Web-exclusive Resources: Five Capitalist Countries & How They Do It

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