Hospital Financing in Seven Countries (Part 7 of 11)

ermany has a federal political system and 16 states with state-level governments. Like its political system, Ger-many's health care system is strongly influenced by both the federal and state governments. Germany has both private and public provision of health care. On the supply side, doctors and pharmacists are independent, private providers. Most hospitals are not publicly owned, but more than half of all hospital beds are in public hospitals. On the demand side, statutory health insurance—compulsory for many employees—is organized by associations (called sickness funds) under public law and covers almost 90 percent of the population; private health insurance covers most of the rest. The statutory sickness funds are primarily financed through income related premiums. Premium stability requires that the growth of health care expenditures not exceed the growth of em-ployees' incomes. Stability of income contributions has been made a cornerstone of German health policy, which also applies to the hospital sector. Germany's pluralism in health care is also marked by the influence of several interest groups. Sickness fund and provider organizations exist at different regional levels (including federal associations). These interest groups play a prominent and well-defined role in regulating the provision and financing of health care, subject to legal control by public authorities. An example of a nonpublic regulatory entity is Concerted Action in Health Care (Konzertierte Aktion im Gesundheitswesen), which includes all the major parties involved in the provision of health care and health insurance as well as representatives from labor unions, employers , and public authorities from the community to the federal level. The group issues proposals for problems concerning health | 75