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Hechos Sobre Alemania Historia Alemana Recetas Alemanas |
Desarrollo del sistema del cuidado medico en Alemania Casi cada uno que reside en Alemania es acceso garantizado al cuidado médico comprensivo de alta calidad. El seguro médico estatutario (Gesetzliche Krankenversicherung -- GKV) ha proporcionado un marco de organización para la entrega del cuidado médico público y ha formado el papeles de pagadores, los fondos del seguro o de la enfermedad, y los abastecedores, los médicos, y los hospitales desde que el acto del seguro médico fue adoptado en 1883. En 1885 el GKV protección médica proporcionada para 26 por ciento de los segmentos bajo-pagados de la mano de obra, o 10 por ciento de la población. Como con seguro social, la cobertura del seguro médico fue ampliada gradualmente incluyendo a grupos siempre más ocupacionales en el plan y constantemente levantando el techo de la renta. Ésos que ganaban menos que el techo fueron requeridos participar en el programa del seguro. En 1995 el techo de la renta era una renta anual alrededor de DM70,00 en el viejo Länder y de DM57,600 en el Länder nuevo. En 1901 transportes y los oficinistas vinieron ser cubiertos por el seguro médico público, seguido en 1911 por los trabajadores agrícolas y de la silvicultura y los criados domésticos, y en 1914 por los funcionarios. Coverage was extended to the unemployed in 1918, to seamen in 1927, and to all dependents in 1930. In 1941 legislation was passed that allowed workers whose incomes had risen above the income ceiling for compulsory membership to continue their insurance on a voluntary basis. The same year, coverage was extended to all retired Germans. Salespeople came under the plan in 1966, self-employed agricultural workers in 1972, and students and the disabled in 1975. The 1883 health insurance law did not address the relationship between sickness funds and doctors. The funds had full authority to determine which doctors became participating doctors and to set the rules and conditions under which they did so. These rules and conditions were laid down in individual contracts. Doctors, who had grown increasingly dissatisfied with these contracts and their limited access to the practice of medicine with the sickness funds, mobilized and founded a professional association (Hartmannbund) in 1900 and even went on strike several times. In 1913 doctors and sickness funds established a system of collective bargaining to determine the distribution of licenses and doctors' remuneration. This approach is still practiced, although the system has undergone many modifications since 1913. The formation of two German states in the second half of the 1940s resulted in two different German health systems. In East Germany, a centralized state-run system was put in place, and physicians became state employees. In West Germany, the prewar system was reestablished. It was supervised by the government but was not government run. According to the Basic Law of l949, Germany's constitution, the federal government has exclusive authority in public health insurance matters and sets broad policy in relation to the GKV. The government's authority applies in particular to benefits, eligibility, compulsory membership, covered risks (physical, emotional, mental, curative, and preventive), income maintenance during temporary illness, employer-employee contributions to the GKV, and other central issues. However, except for the funding of some benefits and the planning and financing of hospitals, the responsibility for administering and providing health care has been delegated to non-state entities, including national and regional associations of health care providers, Tierra hospital associations, nonprofit insurance funds, private insurance companies, and voluntary organizations. Portability of coverage, eligibility, and benefits are independent of any regional and/or local reinterpretations by either insurers, politicians, administrators, or health care providers. Universal coverage is honored by any medical office or hospital. Check-ins at doctors' offices, hospitals, and specialized facilities are simple, and individuals receive immediate medical attention. No one in need of care can be turned away without running a risk of violating the code of medical ethics or Tierra hospital laws. The health care system has achieved a high degree of equity and justice, despite its fragmented federal organization: no single group is in a position to dictate the terms of service delivery, reimbursement, remuneration, quality of care, or any other important concerns. The right to health care is regarded as sacrosanct. Universality of coverage, comprehensive benefits, the principle of the healthy paying for the sick, and a redistributive element in the financing of health care have been endorsed by all political parties and are secured in the Basic Law. By the mid-1990s, health care benefits provided through the GKV were extensive and included ambulatory care (care provided by office-based physicians), choice of office-based physicians, hospital care, full pay to mothers (from six weeks before to eight weeks after childbirth), extensive home help, health checkups, sick leave to care for relatives, rehabilitation and physical therapy, medical appliances (such as artificial limbs), drugs, and stays of up to one month in health spas every few years. Persons who are unable to work because of illness receive full pay for six weeks, then 80 percent of their income for up to seventy-eight weeks. In an attempt to contain costs, beginning in the 1980s some of these benefits required co-payments by the insured. Although these fees were generally very low, some co-payments were substantial. For example, insured patients paid half the cost of dentures, although most other dental care was paid by health insurance. The system has managed these achievements relatively economically. In 1992 about 8.1 percent of the gross domestic product went into medical care, or US$1,232 per capita, compared with 12.1 percent of GDP and US$2,354 per capita in the United States. Even so, Germany devoted about one-third of its overall social budget to health care, an amount surpassed only by retirement payments. The German health care community has made a serious and sustained effort to control the growth of health costs since the mid-1970s. The steep rise in health expenditures in the first half of the 1970s prompted the passage of the Health Insurance Cost Containment Act of 1977. The law established an advisory board, the Concerted Action in Health Care, to suggest non-binding guidelines for health care costs. Chaired by the federal minister for health, its sixty members represent the most important interest groups having a stake in health care. The board has contributed to slowing the growth of health care costs, but further legislation has been necessary. Modest co-payments for medications, dental treatment, hospitalization, and other items were introduced in 1982 for members of sickness funds. These payments were further increased by the Health Care Reform Act of 1989 (Gesundheitsreformgesetz--GRG) and again by the Health Care Structural Reform Act (Gesundheitsstrukturgesetz--GSG) of 1993. The GSG also introduced new regulatory instruments to monitor more closely access to medical practice, to reorganize sickness-funds governance, and to control medication costs and prospective hospital payments. In addition, it proposed measures to overcome the separation between ambulatory medical care and hospital care that prevailed in the former FRG. * Desarrollo del sistema del cuidado medico
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