Statutory Health Insurance Case Study

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Jürgen, a legal resident of Germany, has recently suffered a stroke and must utilize his country’s healthcare system. Since he is a legal resident of Germany, he will have access to insurance through various not-for-profit health insurance funds called “sickness funds” (Blümel and Busse 2014). Through the Statutory Health Insurance (SHI) scheme, these not-for-profit organizations all must guarantee issue. This means that Jürgen will have access to an insurance program regardless of his medical background; he will also have the opportunity to choose between different available plans. These plans are available to Jürgen regardless of his age and geographic location in Germany. These plans are also available to Jürgen regardless of his income. …show more content…

In Germany, the health insurance system includes both public-sector and private-sector insurance companies. The public-sector insurance groups are part of the SHI system and include more than a hundred sickness funds (Blümel and Busse 63). For sickness funds, individuals and their employer split the mandatory contributions, individuals contributing 8.2 percent of their income and employers paying another 7.3 percent (Blümel and Busse 64). These monthly contributions are capped at €630 (or 804 US dollars), which encompasses both employee and employer contributions. These required contributions apply to pensioners and their pension funds, respectively (Blümel and Busse 64). In this way, people pay depending on their income, not based on their health status. If Jürgen is low-income, he would pay less money per month than if he were high-income. Anyone covered under SHI also can rest assured that coverage is extended to dependents as well, which includes children and unemployed spouses. Through general taxes, the federal government of Germany funds certain SHI perks such as free coverage for children. (Blümel and Busse 64). Since SHI sickness funds are all nonprofit, depending on whether revenues are too low or high, individuals may be charged an additional premium or paid an annual bonus. In 2014, none of the sickness funds had to charge extra premiums, and around twenty even paid bonuses upwards of €263 (or …show more content…

Most of the population, about 86 percent, receive coverage through nonprofit sickness funds within the statutory health insurance (SHI) scheme, while about 11 percent are covered through substitutive private health insurance (PHI). The remainder of the population are covered via special programs (Blümel and Busse 63).
Due to guaranteed issue in Germany, Jürgen, or any citizen, will not be denied healthcare coverage because of a particular illness. In addition, no citizen will be denied coverage because of a pre-existing condition either. The same standard applies to all citizens, regardless of age or wealth. In fact, although the German government does not directly finance or provide health care, it watches the country’s nonprofits and for-profits very closely to make sure that they do not increase any patient’s insurance rates or stop providing coverage as the patients grow older or sicker

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