The healthcare is the responsibility of federal
states(L?nder) but the federal central government has the authority
to set legal guidelines for health care. The fast majority of
population is covered under the Mandatory Social Health Insurance
Programme (88%) but, at present, more than 7 million people are
privately insured. There exist about 500 health insurance funds,
whose legal status is private non-profit entity (public law corporation).
They are organised on the basis of occupation, region or employer.
The actual provision of care is carried out by
facilities owned by the local authorities or by independent private
non-profit (charity) or for profit organisations. Each state may
establish their own health financing laws. The financing of the
recurrent costs is carried out by the independent health insurance
funds, which account about 60% of all health financing. (The states
tax financing accounts 21%). The health insurance scheme is divided
into two categories. Employees with a monthly income must be insured
under one of the statutory health insurance schemes which are
financed by equal (50:50) contributions from insured employees
and employers (about 14 % of gross wages and salaries). Anyone
whose earnings are above the ceiling can opt for exemption from
his insurance liability and join one of the 17 private schemes.
For patient the primary care is totally free of
charges. For specialised institutional care the patients has to
pay a flat co-payment up to 14 days per year. Thereafter there
is no out-of-pocket liability. Pharmaceuticals on the positive
list have co-payments according to the reference prices. There
is no coverage for drugs on the negative list.
Outpatient care is provided in doctors offices
based on fee-for-service payments from insurance funds. The private
outpatient physicians may even compete on patients with hospitals.
Hospitals are funded by a combination of government subsidy for
investments (7%) and statutory and private health insurance sources
(93%) based on flexible budgeting. Traditional per diem payment
system has been changed towards the performance related one and
all hospitals have to start to use DRG s in 2007. Today more than
50% of hospitals are already doing so.
The responsibility for planning and financing the
major investments lays on public authority who at sate level approves
major investments projects according to the plan. The university
teaching hospitals gets and extra 20% from the state budget to
cover the higher costs because of teaching and research activities.