German healthcare is in change and Danish companies can be part of this! The current topics in German healthcare might sound familiar for Danish companies. However, Denmark is - in some areas - a step ahead of Germany and has collected experiences from its own transformation process. The delegation visit in May 2015 provides an optimal platform to share best practices with German stakeholders.
Danish companies can contribute to the following topics in German healthcare:
Coordinated care: The gap between the inpatient and outpatient sector and the lack of interfaces and structures for a comprehensive intersectional, transparent communication, and efficient processes is one of the biggest challenges in the German healthcare system.
E-health/telemedicine implementation to improve care processes. E-health will be implemented by law in the course of this year, but there are still many questions, e.g. regarding funding, data security etc.
Elderly care. Demographic change is now! Funding, lack of professional staff and inefficient processes are the main issues, as well as the general question how we would like to spend the last phase of our life. How will elderly care concepts change due to this?
Patient empowerment/patient centricity: In times of well-informed patients, answers have to be found: How will the patient’s role change and how should the healthcare system adapt to this? How can the treatment be more efficient, if the patient is involved (increase of adherence etc.)?
Prevention of chronic diseases
In 2012, Germany spent over 300 billion Euro (= 11,3% of the GDP) on Health (2007: 245.0 billion Euro). Per capita the expenditure was 3.740Euro (2007: 2.970 Euro). This is one of the highest shares in the world.
The German health security coverage is dominated by the statutory health insurance (Gesetzliche Krankenversicherung, abbr. GKV): Almost 90 % of the population is insured by this type of insurance. The remaining 10 % is either covered by private insurance funds or governmental schemes. The health insurance funds within the GKV are the collectors, purchasers and payers of statutory health and long-term care insurance.
The main characteristic of the German healthcare system is the so called “Selbstverwaltung” (self administration), consisting of representatives of the GKV, their joint associations, doctors’ associations, patient organizations as well as the German Hospital Federation. These stakeholders form a superior Federal Joint Committee, the “Gemeinsamer Bundesausschuss” (abbr. G-BA) that defines the content of medical care in Germany.
The “Sozialgesetzbuch V” (5th German book of the Social Law, abbr. SGB V) provides the legal basis of the German Health Care System. While the legislator is the “Bund” (the Federation), the role of the self administration respectively the G-BA is to specify whether specific treatments, pharmaceuticals and medical aids etc. are reimbursed by the GKV. In this connection, the “Institute für Qualität und Wirtschaftlichkeit im Gesundheitswesen” (Institute for Quality and Efficiency, abbr. IQWiG) – established in 2004 – conducts cost benefit studies of pharmaceuticals, surgical procedures, diagnostic tests, clinical practice guidelines, and aspects of disease management programs.
According to the German Hospital Federation there are 2,045 hospitals (2011) with 502,000 beds and an utilization degree of 77.3 % and an average of 7.7 hospital stay days. Compared to some of Germany’s neighbour countries as e.g. the Netherlands or Denmark, these numbers are of course very high. The political willingness to adapt the country’s hospital structure to current and future market conditions has thus become stronger. Adjustments due to demographics, chronic, and multi morbid patients, centralization of treatment, higher quality, and efficiency will lead to a consolidation in the German hospital sector within the next few years.
The rehabilitation sector is a German “specialty”. There is a long tradition of inpatient rehabilitation which is reflected in the number of rehabilitation centers: in 2011 there were 1,233 facilities with 170,500 beds and a utilization degree of 78.7 percent. Typically patients receive rehabilitation after a severe internal or orthopedic illness. As an average, patients stay 25 days in a rehabilitation clinic.
Elderly care in Germany is high on the political agenda due to demographics and related challenges (urbanization, single households, funding etc.). The Ministry of health has recently passed an amendment of the elderly care law which – among others - shall strengthen care of patients with dementia. Ambulant care is still the major focus. According to the latest statistics of 2011, 2.5 million people receive elderly care, 1.76 million receive care in the ambulant sector, 743,000 live in 12.400 elderly care homes. The market for elderly care is growing in Germany, investors are looking at the institutional sector. The challenges remain: Germany is lacking professional care staff, the funding of elderly care is unstable and the interfaces to other healthcare sectors do not work properly and efficiently enough.