1. Health Care guaranteed – The Right to Health in Germany Which Lessons could be learned about or from Germany? Remarks by Franz Knieps, Managing Partner at Wiese Consult GmbH, former Director-general in the Federal Ministry of Health, Berlin 1

2. Health Care guaranteed – The Right to Health in Germany Main principles of the German health care system  Public / private mix of insurers and providers  Nearly 100% of population covered  Shared responsability of federal, state, community authorities  Dominant role of self-administration, weak role of the state  11% of GDP for health care costs  Wide range benefit package  Comparable low co-payment level 2

3. Health Care guaranteed – The Right to Health in Germany Legal framework  No right to health in Basic Law (Constitution), but deducted from the right of life  Guaranteed by the Social Code and by jurisdiction of the Constitutional Court  Protected by Anti Diskrimination Law and the jurisdiction of Federal and State Courts  Supervised by Federal and State Insurance Authorities  Violations punished by federal and professional laws 3

4. Health Care guaranteed – The Right to Health in Germany Real situation – Strengths  No formal hurdles to access for the whole population  Free choice between funds and providers  Indications for oversupply and information overkill  No formal waiting lists (except transplantations)  Easy access to medical, technical, pharmaceutical progress  Strong legal position of patients and insured 4

5. Health Care guaranteed – The Right to Health in Germany Real situation - Weaknesses  Health status depends on social status (income, education, origin)  Variations of care and lack of integrated of service  Focus on acute care and dominant role of physicians esp. specialists  Providers favour privately insured  Lack of (written) patient rights and health policy strategies  Neglecting Primary care esp. In rural areas Access for (illegal) migrants Children in poverty Mental diseases esp. Dementia  Also indication for oversupply  Information overkill 5

6. Health Care guaranteed – The Right to Health in Germany Future challenges  Demografic change Population Health professionals  Cost of medical progress  Globalization and Migration  Urbanization  Ethics  Sustainable financing 6

7. Health Care guaranteed – The Right to Health in Germany Possible answers  Common insurance market for public and private insurers  Focus a (national) public health strategy on Prevention and health promotion Evidence based care Chronic care, rehabilitation, long term care Outcome measurement and pay for performance, especially for vulnerable groups (e.g. children, migrants, poor, elderly)  Passing a patient protection law  Improving health education and patient coaching  Patient empowerment and shared decision making  Developing new models of (integrated) care for the whole population 7