Structure and institutions of the health care system

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The health care system in Germany is based on four basic principles: Compulsory insurance: Everyone must have statutory health insurance ("gesetzliche Krankenversicherung" - GKV) provided that their gross earnings are under a fixed limit ("Versicherungspflichtgrenze"). Anyone who earns more than that can choose to have private insurance ("private Krankenversicherung" - PKV). Funding through insurance premiums: Health care is financed mostly from the premiums paid by insured employees and their employers. Tax revenue surpluses also contribute. To give you an idea of what this means: State-funded health care systems like those in Great Britain or Sweden draw on tax revenue. In market-oriented systems such as that in the United States, many people have to carry the costs of treatment and loss of earnings due to illness themselves, or have to get private health insurance. Principle of solidarity: In the German health care system, statutory health insurance members jointly carry the individual risks of the costs of medical care in the event of illness. Everyone covered by statutory insurance has an equal right to medical care and continued payment of wages when ill - regardless of their income and premium level. The premiums are based on income. This means that the rich can help the poor, and the healthy can help the ill. However, these premiums are only calculated based on a percentage scale up to a certain income level ("Beitragsbemessungsgrenze"). Anyone earning more than this amount pays the same maximum premium. Principle of self-governance: While the German state sets the conditions for medical care, the further organization and financing of individual medical services is the responsibility of the self-governing bodies within the health care system. These are made up of members representing doctors and dentists, psychotherapists, hospitals, insurers and the insured people. The Federal Joint Committee ("Gemeinsamer Bundesausschuss" or G-BA - please also see below: "Structure and institutions of the health care system") is the highest entity of self-governance within the statutory health insurance system.

Reference no: EM133657588

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