Welcome to Module 3 of Comparative Health Systems. In this module, we're reviewing the healthcare systems into high-income countries. Germany has a population of 81 million and a per capita GDP in US dollars of 50,800. The United Kingdom by contrast is slightly smaller with a population of 65 million and a per capita income in US dollars of 44,300. When we review these healthcare systems, it's important to note and remember that both countries are significantly smaller than the United States. The United States has a population of 329 million and a per capita GDP of $59,800. That is significantly greater than both Germany and England. This is relevant when we come to consider the levels of spending with reference to GDP. Both Germany and England support systems of universal health coverage. Governments create frameworks that are aimed at providing universal health coverage. This includes providing access to care for the entirety of their populations while also controlling the cost of providing that care. The goal of providing universal health coverage includes those of improving the quality of healthcare, including the safety and effectiveness of healthcare for all people, while also seeking to improve overall population health. Germany is what is described as a system of social health insurance, sometimes referred to as the "Bismarck" model after Otto Bismarck who introduce social insurance in 1893. England has a National Health Service which was created after World War II as a formal conscious decision by the government of the United Kingdom. Both Germany and England created self-governing or self-regulating systems of care to achieve these multiple sets of public policy goals. Government in each of these countries aims to influence the building blocks in these systems of care in order to influence the outcomes produced by those systems in relation to quality, cost, and population health. In both cases, governments are at arm's length in relation to the governance of these health systems, payment systems for services provided to patients and systems of delivery for health care services. Governments are concerned with influencing the path or direction of the healthcare systems. This is significant in both countries. It was partly because of the experience of national socialism in the Third Reich that modern Germany governments avoid direct involvement either in the governance of health systems or in the direct provisions of healthcare services. England, when the government created the National Health Service, it established the principle governments should not intrude into health care decisions by doctors and patients. In Germany, the system of social health insurance is governed by a principle of solidarity. That is that the size of contributions to social insurance funds are based on the ability to pay while access to services is dependent on need. Contributions to social health insurance are compulsory and are shared with employers and social insurance funds are self-governing. In the United Kingdom, the National Health Services is funded predominately by taxes, which is itself an expression of the principle of solidarity on a national scale. The process for the creation of universal health coverage in Germany was a gradual one. Otto Bismarck first introduced the system of social insurance in 1883. By 1896, 10 percent of the workforce was covered by a system of social insurance. By why footnote, there were by 1896 some 18,766 sickness funds administering systems of social insurance. By 1914, social insurance covered 37 percent of the population and 23 million individuals. After World War II, there was a gradual expansion of social health insurance coverage. By 1987, it was mandatory for farmers, disabled persons, students, and artists to have social health insurance. During this period, the federal government in Germany contributed to the system of social health insurance by making payments on behalf of the unemployed. By contrast, the creation of the National Health Service in England was a conscious act of the government after World War II. It established a system to provide healthcare services to the whole of the population of the United Kingdom. The National Health System is now governed by these principles set out in the constitutions of the National Health Service and these principles are included on this slide. That is, that the National Health Service provides a comprehensive service available to all. That access to the services is dependent on need and not on ability to pay. The NHS provides a higher standards of excellence and professionalism. The patient will be at the center of everything that the NHS does, the NHS works across organizational boundaries and is committed to providing best value for taxpayers money. This is significant because a national health service is funded nearly completely by tax revenue. Finally, that the NHS is accountable to the public in the communities and patients that it serves. In the following segments of the lecture, we will review each of the building blocks in Germany and the outcomes of the healthcare system in Germany.
