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Take Home Exam MGH4004
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Take Home ExamGoverning Health in a Global Context
Tina Boersma (I6052404)
Maastricht University
Master Global Health
Course: MGH4004
Date: 29-10-2016
Word count: 4323
, Elaboration question 1
Introduction
In the 21st century, National Health Systems are highly dominated by public, private or mixed
healthcare provision. Public health care refers to national healthcare coverage through
governmental provision (Basu, Andrews, Kishore, Panjabi, & Stuckler, 2012). In contrast, private
health care includes non-governmental organisations, social enterprises, for-profit companies as
well as numerous private providers (Hanson et al., 2008). In fact, according to Mackintosh et al.
(2016) the private sector refers to the sum of ‘privately owned institutions and individuals providing
health care, including private insurers’(p.5).
Especially in the context of globalisation and neoliberalism, governments’ shift from public
to private healthcare providers is noticeable (Brugha & Zwi, 2002). In many low- and middle
income countries healthcare provision is increasingly allocated to private providers. According to
Mackintosh et al. (2016), domination of private healthcare is detrimental due to the fact that less
well-off struggle to access fee-for-service costs. On the other hand, Hanson et al. (2008) stress
that appropriate private healthcare provision depends on the context every nation acts in. Hanson
et al. (2008) clarify their argument by saying that ‘in some environments ensuring quality care
through private provision may prove to be effective in reaching the poorest, in other settings, it may
be more appropriate to focus on improving the way that public providers operate’ (p.1529).
Based on this information, the following essay critically reflects on the privatization of the
German health care system as a high income country. Benefits as well as its disadvantages are
taken into account. Furthermore, an elaboration concerning an optimal mix between public and
private health is given followed by a contribution of these mixture among the implementation of the
principles of the Alma Ata Declaration.
Privatization of German healthcare system
Before examining the privatisation process of the German healthcare, it is of great importance to
give a brief overview regarding the major characteristics of the system. In Germany, healthcare is
provided within a dual system, containing a compulsory insurance and a private insurance
(Germany Health Insurance System, 2016a). The compulsory or statutory insurance occupies a
fundamental position in the healthcare system since approximately 90 per cent of all citizens are
covered by this type. German’s with a gross income of less than 4,462.50 EUR per month are
automatically enrolled in public non-profit sickness funds (Bundesärztekammer, 2016). Better-off
citizens have the opportunity to supplementary coverage, based on an individual agreement
between insurance company and insurance person itself (Germany Health Insurance System,
, 2016b).
Another point to consider is that healthcare facilities such as hospitals are grouped into
three main categories in Germany. The first category includes local hospitals which are driven by
local authorities as well as different towns. The second category implies voluntary, non-profit
making hospitals, headed by churches or non-profit organisations as for instance the German Red
Cross. Last but not least, the last category indicates private hospitals, directed as free commercial
enterprises (Bundesärztekammer, 2016).
Among the last two decades Germany faced an enormous shift, turning public hospitals into
private ones (Roeder & Labrie, 2012). These private hospitals are neither owned by any level of
government (municipal, state, federal) nor other public bodies. It is worth noticing that private
hospitals fully operate within the public health system, and treat all patients regardless of statutory
or private insurance (U.S. National Library of Medicine, 2015). Nevertheless, the privatisation of
hospitals as well as the distinction between statutory and private insurance is associated with a
couple of benefits and disadvantages, which are presented below.
Benefits and disadvantages
A major benefit of private insurances within Germany is that patients have free doctor and hospital
choice, including better treatment. Especially in the context of patient-provider relationship,
flexibility of choosing a favourable health practitioner is highly appreciated by clients. Another
crucial advantage of being privately insured is that medical appointments are associated with
shorter waiting times. In particular when having a surgery that is necessarily, long waiting times are
annoying and hamper clients’ satisfaction (Roeder & Labrie, 2012). On top of that, private
insurance fees do not depend on the individual income, but are based on the persons’ age and
health status. Hence, students can close a convenient contract due to their young age and
prospering health status (Germany Health Insurance System, 2016b).
On the other hand, promoting private health insurances is not in line with equality principles.
The differentiation between public and private healthcare creates a two class society with private
patients and providers at the top and public ones at the very bottom. Based on this assumption,
welfare state Germany is fragile to corruption, market-driven mechanisms and consequently
ignores that health is no good or commodity but a fundamental human right that has to be fostered
in a sustainable way (Zvieriev & Kollonay-Lehoczky, 2009).
However, when taking a closer look at the benefits of privatisation of German hospitals it
gets obvious that profit-orientation is an essential issue. Since the shift from public to private
hospitals, pressure on hospitals’ performance has dramatically increased. Consequently,
reorganisations of processes within a hospital are executed faster and restructuring plans are
carried out more efficiently (Roeder & Labrie, 2012). Due to additional access to capital, private for-
profit hospitals have advantages concerning the realisation of necessary investments. As a result,
these hospitals have the highest investment per case, offering state-of-the-art treatments and
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