Can China use experience of German healthcare system in its reform?

Presenter: Hengjin Dong, Heidelberg University

Abstract

Rationale: The German health care system is a so-called Bismarckian system with a statutory social health insurance (SHI) system that covers almost 90 percent of the population. The system dates back to year 1883, when the German parliament passed a law that made health insurance nationwide mandatory for certain employees. This statutory health insurance system was built upon existing voluntary or mandatory local schemes of social insurance and based on the solidarity and pay-as-you go principles.

Objectives: this study aims to summary the characteristics of German health care system especially in the area of health care financing and opens a discussion topic ‘can German experience used in China’s healthcare system reform?’

Methodology: literature and document review

Results: The system started with small, voluntary and informal risk-sharing schemes. Then they transferred from informal to more formal, from voluntary to compulsory, and from small to larger schemes. The benefit package changes from narrow to broader. Currently, the benefit packages of all schemes are similar but there is difference in the contribution rates. Co-payment is used for services especially for drugs and dental care, but using bonus for encouraging health promotion. People have free choice of schemes and providers. Some small schemes merge to a larger scheme. Risks are adjusted among schemes for gender and age. The decision-making powers are shared between the states, the federal government and legitimized civil society organizations, such as the SHI-affiliated physicians’ and dentists’ associations on the provider side and the sickness funds and their associations on the purchasers’ side, as well as the German Hospital Organization.

Discussion and conclusion: Can German experience used in China’s healthcare system reform? Some of experience is useful for China’s decision makers, such as voluntary to compulsory, from small schemes to larger schemes.