How liked the health system in Germany

Disease and society

The German health system is generally considered to be in very good condition. The density of doctors, hospitals and beds is high, the equipment with medical-technical devices is hardly unequaled anywhere in the world, (almost) the entire population enjoys health insurance cover, the catalog of benefits provided by statutory health insurance is as comprehensive as in hardly any other country. In addition, employment growth and wage increases bring the health insurances high income, so that even the otherwise ubiquitous call for cost containment was only heard occasionally, and then not particularly strongly.

At the same time, the German healthcare system is facing numerous, major challenges in various fields. This article focuses on three key areas: the upgrading of prevention and health promotion while reducing the social inequality of health opportunities; ensuring health care while the need for skilled workers grows; the necessary overcoming of the traditional separation of statutory (GKV) and private health insurance (PKV).

Prevention, health promotion and social inequality

Prevention and health promotion have gained significantly in importance in recent years. A distinction is made between primary, secondary and tertiary prevention. Primary prevention tries to tackle the causes of illnesses before they break out, whereas secondary prevention aims to identify illnesses as early as possible and avoid their progression or postpone it for as long as possible. Tertiary prevention tries to prevent consequential damage.

The reasons for this increase in importance are different. [1] Of particular importance is the insight that the intervention options of modern medicine are growing, but after chronic diseases have occurred, they are limited in many cases and also quite expensive. By strengthening prevention and health promotion, health policy does not only want to relieve contributors - not least employers - and public budgets of costs. It is also about strengthening health as a productivity resource in the face of an aging population and a lack of skilled workers that is emerging or has already occurred in many areas. Prevention and health promotion are intended to help curb the growing risk of absenteeism due to incapacity for work and to enable employees to continue working up to the retirement age of 67 and possibly beyond and to be able to do voluntary work after retirement, for example to do tasks in to take care of the elderly. [2] Prevention and health promotion are therefore based on a strong economic motive, even if they cannot be restricted to them.

Despite the increased attention, prevention policy in Germany is characterized by serious shortcomings. Overall, primary prevention and health promotion have far too little weight when measured against their potential. Instead, ineffective attempts at behavior prevention dominate, which only influence individual behavior, while complex life-world-related and participatory projects that pursue the health-friendly design of living and working conditions and in particular aim to improve the living situation of disadvantaged groups and strengthen their action resources play a minor role play.

Behavioral prevention campaigns with a focus on smoking, diet and exercise have grown in importance over the past few years. Numerous of the health risks associated with gainful employment, such as precarious employment (temporary work, fixed-term employment, etc.), the duration and location of working hours, the significantly increasing workload with its diverse psychological and somatic consequences (e.g. stress, burn-out and associated psychological and psychosomatic illnesses), on the other hand, do not receive the necessary attention. The negligence with which political decision-makers react to traffic-induced particulate matter pollution is an indication that the willingness to create healthy living conditions is nowhere near as great as the health risk posed by these pollution would require. Attention to the social inequality of health opportunities also remains well below the social significance of the problem. [3]