Decision-making powers are traditionally shared between national (federal) and state (Land) levels, with much power delegated to self-governing bodies in German health care system. It provides universal coverage for a wide range of benefits. Since 2009, health insurance has been mandatory for all citizens and permanent residents, through either statutory or private health insurance (2019).
The good governance in Germany has led to many organizations supporting its health care system and thus its population is able to get good services as its federal government really support the sector as health insurance is compulsory to its citizens.
The German health system is split into an insurance sector with public and private insurance funds, and a healthcare sector. The Healthcare sector covers a scope of services and departments, including ambulatory outpatient care which is mainly given by sole doctors at their offices, pharmaceutical care distributed by pharmacists, inpatient care in hospitals and rehabilitation clinics, and a nursing care sector for the increasing elderly population. It is a composite network of an interesting batch that shapes the link between this structure and the political arena. The 2000 hospitals, for example, are constituted by the German Hospital Federation. These heed groups act as legitimate partners of the political and democratic process in opinion and decision-making.
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The earliest health care system in Germany was dated in 1893 with Otto von Bismarck’s social legislation (Porter M. E., 2012) having various insurance bills stressed and applied only to low income and certain government employees. Two years later the private health care plans kicked off and have given rise to gradual changes in covering its population as development amendments were done through its rise stopped during the second world war in 1945. after the second world war, Germany experienced economic growth which led to the expansion of its health care system to a point where its population got fee-for-service reimbursement system (Porter M. E., 2020) which was introduced in 1955.
In 1976 a commission based on the government policies with recommendations on targeted expenditure was established, as the system, some laws (1977, 1981) was approved to reduce the costs, and also led to the betterment of bills as the system was integrated between the health insurance fund and the providers (Amelung, 2012)
The organization of the German health care system is easiest to describe due to the separation of powers due to federal, land, and corporatist levels.
This level has federal assembly, federal council, and Federal Ministry of Health as the key players in the health care system; the Federal Ministry of Health is organized into six departments. The Ministry of Health is advised by various ranges of committees and the Advisory Council of the health care system.
Licensing and supervisory functions, scientific consultancy work and information services the ministry of health provides to the population and scientific community are assisted by subordinate agencies like the Federal Institute of Pharmaceuticals and Medical Devices responsible for authorizing pharmaceuticals and supervising their safety and that of medical devices, Federal Institute of Vaccines and Biomedicines responsible for licensing vaccines and biomedicines, The Robert Koch Institute responsible for surveillance, detection, prevention and control of diseases among others.
Federal of Financial Supervisory Authority is also relevant to the health care system as it is responsible for private insurers supervisory while supervising the legality of decisions taken by public corporation administering various insurance schemes is done by the Federal Insurance Authority.
It is divided into 16 land governments and land legislatures of which none of it does have the ministry of health, instead, health services are under other affairs like the social services, family and youth, environment, and consumer protection.
It consists of public corporations based on mandatory on membership institutions such as providers like the physicians and dentists, payers of health services, and other professionals.
Decentralization and centralization:
Decentralization takes different forms but the following order reflects nationality increased level from the central government.
- Deconcentration: this is passing of administrative authority from central government offices to local ministries offices and is of minor importance in the German health care system because most administration levels lack subordinate administrative agencies.
- Devolution: this is responsibility pass and degree of independence to local government with or without financial responsibility, whereby the opposite took place in Germany.
- Delegation: pass of responsibilities to local offices outside the structure of the central government. In Germany, there is a delegation of powers from the central government to corporatist institutions
- Privatization: Transfers of ownership and government functions from the public to private bodies, some sectors in Germany are spearheaded by the private sector like the ambulatory care taken by physicians and dentists, though private-for-non-profit and private-for-profit providers exit in the public institutions like the social care.
