Health Status and Health Care Services in Germany

with comparison to the United States

Table of Contents

Table of contents………………………………………………………………………………… 2
Introduction…………………………………………………………………………………… 3
Statistics Show…………………………………………………………………………………... 4 WHO Health Stats for US……………………………………………………………….. 4 WHO Health Stats for Germany…………………………………………………………. 4
The Big Little People Problem…………………………………………………………………... 5
The Errors of Youth…………………………………………………………………………… 5 “Battle of the Fatties”…………………………………………………………………….. 5
For the Public, By the Public…………………………………………………………………... 6 Drug Abuse Care……………………………………………………………………….... 6 Care for the Mentally Ill…………………………………………………………………. 7 Drug Related Death Rates……………………………………………………….. 7 Suicide Rates…………………………………………………………………….. 7
A Time to Die……………………………………………………………………………………. 8 The Part of Life that is Death…………………………………………………………… 8 The Part of Death that is Fear…………………………………………………………… 8
Conclusion………………………………………………………………………………………. 9
References……………………………………………………………………………………… 10

Introduction The long held belief that the United States is the greatest country on earth has been debated in recent years. Domestic terror attacks, stock market crashes, and a deep recession have challenged the standing of the US amongst other nations. As the US is rebounding from these domestic problems, it is in a legislative battle to reform a long failing health care system. In comparison to European countries, like the example that will be used here, Germany, the US treats the sick as it does any other consumer on the free market in contrast to the sick being treated as a human beings. The health care system in the US is not failing because of a lack of high quality care, it is failing because of bureaucracy and inflationary health care costs. When looking at the two side by side there are marked differences in all of the major life expectancy categories (WHO, 2008) which will be the basis for this overall comparison of the US and Germany. The comparison points examined here deal with care from the crib to the grave and the care and cost efficiency of care in every stage of life. The way in which the US and Germany attack the issues infant mortality rate, probability of death among young adults and quality of life for the elderly will be examined to highlight the German system that is and the US system that aspires to be.

Statistics Show According to the WHO Health chart which compiles healthcare data from 193 member states, there is not one vital health category in which the US leads Germany despite spending more per capita and using a greater percentage of its GDP to fund care. These categories show how health care expenditures for each country affect life expectancies across all age demographics.

Statistics US

|Total population |302,841,000 |
|Gross national income per capita (PPP international $) |44,070 |
|Life expectancy at birth m/f (years) |75/80 |
|Healthy life expectancy at birth m/f (years, 2003) |67/71 |
|Probability of dying under five (per 1 000 live births) |8 |
|Probability of dying between 15 and 60 years m/f (per 1 000 population) |137/80 |
|Total expenditure on health per capita (Intl $, 2006) |6,714 |
|Total expenditure on health as % of GDP (2006) |15.3 |
|Figures are for 2006 unless indicated. Source: World Health Statistics 2008 |

Statistics GER

|Total population |82,641,000 |
|Gross national income per capita (PPP international $) |32,680 |
|Life expectancy at birth m/f (years) |77/82 |
|Healthy life expectancy at birth m/f (years, 2003) |70/74 |
|Probability of dying under five (per 1 000 live births) |5 |
|Probability of dying between 15 and 60 years m/f (per 1 000 population) |106/55 |
|Total expenditure on health per capita (Intl $, 2006) |3,328 |
|Total expenditure on health as % of GDP (2006) |10.4 |
|Figures are for 2006 unless indicated. Source: World Health Statistics 2008 |

From the data it can be inferred that although the US is spending more money on healthcare, it may not be spending it in the right places.
The Big Little People Problem It is difficult to believe that the US, the most industrialized country in the world, would have disturbing rate of infant mortality compared to like nations. In the WHO Health report, the US ranks 8, while Germany ranks 5. The CDC published more dramatic statistics reporting that the US “ranked 29th in the world in infant mortality in 2004, compared to 27th in 2000, 23rd in 1990 and 12th in 1960.” The ratio of death/live births for the US in 2004 was 6.78/1000, in contrast to only 4.2/1000 in Germany (CIA, 2011). Contributing to the steadily increasing trend of infant deaths in the US are several factors including “maternal health, quality and access to medical care, socioeconomic conditions, and public health practices”(CIA). Comparatively, Germany’s infant mortality rate is steadily decreasing partly due to a health care system that provides access to all citizens that pay into a national health account (Hasson, 1993), and a population that is more ethnically homogenous than the US. The infant mortality rate in the US is heavily influenced by African-Americans and Hispanics who make up 28.7 % of the population (US Census, 2009) and 13.63% and 13.83% (statistic is a combination of Mexican and Puerto Rican descendents) of the infant mortality rate respectively (MacDorman, 2008). These ethnic groups are less likely than their Caucasian counterparts to receive quality prenatal care whether the issue is lack of access or cost of care.(CIA, 2011).
The Errors of Youth Life expectancy across all age segments is greater in Germany than in the US. As noted in the WHO Health statistics, the probability of an adult between the age of 15 years and 60 years dying is almost 30 times more likely for males and females in the US than in Germany (2008). The German diet in comparison to the US diet is a non-factor since it has been noted that both countries are in a “battle of the fatties” (Hall, 2000). A statement from Professor Manfred Muller of Christian Albrecht University on the German obesity crisis could easily be mistaken for a statement on obesity in America. “He blames a national diet loaded with fats and sugars - sausages, beer, pork knuckles, sweet pastries - which has scarcely changed since the 1950s, coupled with an influx of American fast-food joints designed to appeal to ever-younger children” (Hall). The disparity is not caused by a difference diet, rather, a contrast is found in the direct and immediate access the German populous has to health care providers. A correlation can also be made by examining German attitudes to disease and treatment versus the attitudes held by Americans.
For the Public, By the Public In Germany, almost 90% of its citizens “join one of the 300 statutory sickness funds (Cackett, 2005). In the US, insurance is provided through health companies which are privately (e.g. HMOs and PPOs) or semi-privately (e.g. Blue Cross/Blue Shield) owned (AD Banker, 2010) and adhere to free market practices of charging whatever the market will bear. Since these companies complicity work for the benefit of their stockholders and not for the insured, validity of premium prices and necessity of treatment questions arise. Additionally, Germans are “free to visit any doctor they like. They may either walk in off the street, or ring for an appointment that will invariably be booked for the same morning or afternoon.”(Cackett). This is not true in the US where doctors operating under HMOs and PPOs are restricted as in-service providers and patients may chose an in network doctor but be denied access because patient intake limits set by these companies have been met(AD Banker). This freedom of choice gives Germans a greater control over the quality of care they receive. In Germany, “consumers can and do penalise bad service, (Cackett)”, a practice unheard of in the US. Not only is the ease of access an advantage for Germans, but also the ease of accepting multiple definitions of disease. In Germany, a drug addict is treated with the same vigilance as a cancer patient. Under the US system of privately funded healthcare, coverage is provided for a substance abuse issue when meeting the definition of “an illness where an individual is physiologically dependent upon a controlled substance. (AD Banker)” This definition excludes those who may be psychologically dependent. The Frankfurt Resolution of 1990 sent a revealing message about the German consensus on drug abuse stating that “drug using is for the majority of users a temporary part of their biography, which can be overcome within the process of maturing out of addiction. (Gatto, 1999)” It also identifies “Criminalization as a counterpart to drug aid and drug therapy. (Gatto)” In the US the war on drugs rages on with incarcerating those who would benefit more from rehabilitation. The importance of care for the mentally ill also proves to be a challenging concept for Americans. Germany, on the other hand has a long and storied tradition in the field of psychological study. In a study that compared the US and Germany along with three other countries, Germany rated the best in caring for people with mental illness, “caring for two in three patients.” while the US rated the worst of the five even though it has the largest percentage of mentally ill (Kirchheimer, 2003). Dr. David Duncan of Brown University concludes that “"In the U.S., the government offers some mental health care, but it has generally become inadequate and there's less and less funding for it. (Kirchheimer)” Issues like drug abuse and mental illness that generally onset in young adulthood and can continue for years are keys to the probability of death among this age group gap between the US and Germany among this age group, taking into account death from complications from drug abuse and suicide among the mentally ill. “In 2006, a total of 38,396 people died of drug-induced causes in the United States, (Heron, 2009)” whereas “1,296 drug deaths were recorded in Germany. (BBC, 2008)” The calculated percentage makes the drug related death rate approximately even, however, when the suicide rates in the US and Germany compared; the rates are higher across every age group up to age 54 in the US. The opposite is true beginning at age 55 as Germany then has the higher rates, but the young adult population is highlighted to support findings in this instance (WHO Suicide, 2006).
A Time to Die The WHO comparisons of Germany and the US in regards to healthy life expectancy may provide the most compelling evidence of a clear contradiction between caring for the sick practically versus caring for them systematically. Differences in the quality of care for the senior population in Germany and the US underscore an important difference in ideology. Prolonging life in the elderly is not a standard practice in Germany. Sharon Kaufman expounds on the American thought of death as an enemy rather than a natural transition by noting “normalization of life-extending treatments at older ages promote the notion that aging and death are not inevitable and foster the assumption that one can and should choose to intervene. (2011)” She completes the comparison by adding that the “assumption is not as pervasive in Europe, where the limitations to health care resources are widely acknowledged. (Kaufman). The US spends billions of dollars annually providing life extending treatment for those people who would likely succumb without it. Dr. Ursula Friedrichs, a physician in Germany gives insight into her nation’s outlook on treating the elderly by revealing "If an elderly patient is clearly dying of natural causes, I treat her at home. (Whitney, 1993).” An ocean away, Dr. Michelle Riesner of the Jersey Medical Center finds ““Elderly patients often spend their last days going from one test to another, with the cardiologist looking at the heart, the GI specialist worried about their digestion, the endocrinologist checking on their diabetes and the neurologist concerned about their brain, (Liberty, 2009)” There is a moral hazard that goes both ways; for Germany, adherence to public budget constraints appear to influence thoughts on the value of the life of the elderly, and for the US adherence to a belief that death is to be challenged vigorously appears detrimental to the elder population who many times would rather transition with dignity and peace, not being sustained only by machines and medicines.
Conclusion
The German health care system has long been held as one of the models the US believes could be the answer to its health care crisis. Comparing the two through life expectancy statistics validates that assumption. During the Clinton administration White House spokesman Robert Boorstin conceded that the German system "has attractive features"(Hasson, 1993). In regards to the ongoing health care reform debate, those features have gone from attractive to essential. Pressure on the current administration to control spending due to an enormous deficit and budget shortfalls; have brought about an examination of the costs of maintaining the current health care system. Malpractice reform is one of the most pervasive issues since large settlements against doctors and insurance companies are causing costs to be passed on to patients (Editor, 2009). In addition, with a profit based system, doctors are more likely to over-treat patients to meet the bottom line or conversely “overprescribe costly tests and treatments to avoid possible lawsuits.(Editor)” In Germany, there is not a major malpractice issue, a result of health care not being commoditized. Another ‘attractive feature’ is the ease of access in the German system versus the US. Patients are not on waiting lists and long lines to see providers and the scope of care covers every age demographic and its corresponding issues and needs (Whitney, 1993). There are no middle men, as there are in the US, gatekeepers who decide who one can see, what for, for how long and for how much. After a presumably long life of low cost, low stress healthcare, the directive of the German health care philosophy is to allow nature to take its course and not to preserve life when it is unreasonable and unethical. The US approach lacks this subtly and complexity, throwing hundreds of thousands of dollars after patients who are only alive because of technology. There is so much more the US can learn from the quality of healthcare German’s enjoy. Beyond its cost effectiveness and pragmatism, it provides timely care for those that sustain it; not just for those that can afford it.

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