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INTRODUCTION

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The financing and organization of medical care throughout the developed world spans a broad spectrum. In most countries, the preponderance of medical care is financed or delivered (or both) in the public sector; in others, like the United States, most people both pay for and receive their care through private institutions.

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In this chapter, we describe the health care systems of four nations: Germany, Canada, the United Kingdom, and Japan. Each of these nations resides at a different point on the international health care continuum. Examining their diverse systems may aid us in our search for an improved health care system for the United States.

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Recall from Chapter 2 the four varieties of health care financing: out-of-pocket payments, individual private insurance, employment-based private insurance, and government financing. Germany, Canada, the United Kingdom, and Japan emphasize the last two modes of payment. Germany finances medical care through government-mandated, employment-based private insurance, though German private insurance is a world apart from that found in the United States. Canada and the United Kingdom feature government-financed systems. Japan’s financing falls between the German method of financing and the government model of Canada and the United Kingdom. Regarding the delivery of medical care, the German, Japanese, and Canadian systems are predominantly private, while the United Kingdom’s is largely public.

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Although these four nations demonstrate great differences in their manner of financing and organizing medical care, in one respect they are identical: They all provide universal health care coverage, thereby guaranteeing to their populations financial access to medical services.

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GERMANY

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Health Insurance

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Hans Deutsch is a bank teller living in Germany. He and his family receive health insurance through a sickness fund that insures other employees and their families at his bank and at other workplaces in his city. When Hans went to work at the bank, he was required by law to join the sickness fund selected by his employer. The bank contributes 7.3% of Hans’s salary to the sickness fund, and 8.2% is withheld from Hans’s paycheck and sent to the fund. Hans’s sickness fund collects the same 15.5% employer–employee contribution for all its members.

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Germany was the first nation to enact compulsory health insurance legislation. Its pioneering law of 1883 required certain employers and employees to make payments to existing voluntary sickness funds, which would pay for the covered employees’ medical care. Initially, only industrial wage earners with incomes less than $500 per year were included; the eligible population was extended in later years.

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Eighty-six percent of Germans now receive their health insurance through the mandatory sickness funds, with 11% covered by voluntary insurance plans (Fig. 14-1). The remaining 3% are covered under special programs (Commonwealth Fund, 2015). Some sickness funds are organized by geographic area, some by employer or occupation, and some are nationally based ...

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