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TransKorea    [Video] Sick Around the World 세계의 의료보험 제도 (3/5) 독일



Next, to a country a bit more like the U.S., the nation that gave us aspirin and X-rays, the third richest economy in the world. It's Germany. In many ways, they're just like us. Except, that is, for their health care.

That imposing figure behind me is Otto von Bismarck, the Prussian chancellor in the 1880s, and he's the guy who invented the concept of health care systems, the notion that a government has to provide mechanisms so all its people can get medical care when they need it. And today, the Bismarck model is used all over the world.

Thanks to the Bismarck model, everybody in Germany is offered health care. While the rich are allowed to opt out and pay privately, about 90 percent of Germans choose to stay in the national system. And that system is famous not only for covering all the basics, plus mental health, dental and optical, they also pay for alternative therapies, like homeopathy. They'll pay you to go to a spa. The system's even been known to cover belly dancing lessons.

(이 또한 예방요법의 일부이다.)

As in Japan, the delivery of health care is largely a market affair, carried out by private doctors and private hospitals. I visited Dr Christina von Kockritz, a family doctor practicing in the small town of Kladow, south of Berlin.

If I call your office and say, "Oh, my shoulder kind of hurts. I'm not sure what's wrong," how long would it take me to see you?

Well, two weeks.

Two weeks?

If it's serious, same day.

Serious, same day. If I come in here and you look at my shoulder and say, "Well I think maybe an orthopedic specialist should look at it," then how long would I have wait to see the--

It's different. Perhaps another week or two, yes.

What if the orthopedic specialist said, "Well, we have to operate on your shoulder"? Do you know how long I would have to wait for that?

Not too long. Three weeks.

Three weeks before I could get in.

A guess, yes.

(독일도 … 대기 기간이 긴 편이다.)

That's about the same waiting time as the U.S. It's faster than Britain, but not as quick as Japan would be.

To finance health care, Germans pay premiums based on income to one of 240 private insurers. They call them "sickness funds." A worker earning $60,000 would split a $750 monthly family premium with her employer. It's more expensive than Japan and the U.K., but still a bargain by U.S. standards, about two thirds of ours.

It is a system where the rich pay for the poor and where the ill are covered by the healthy.

(의료보험이 "부의 재분배" 성격을 가져야 하는가 이다.)

This is Professor Karl Lauterbach, a member of the German parliament and one of Germany's foremost experts on health policy.

So it is a nice social support system which is highly accepted by the population.

Katie Haaser is one of those patients. She's having her third baby.

I'm very satisfied with the system, especially during my pregnancy. I think it's maybe not perfect, but it's the best I can imagine.

What does she pay?

Actually, nothing. I don't have to pay anything.

While pregnant women pay nothing, there is a co-payment for most patients. But you'll love this. It costs 10 euros. That's about 15 bucks. And you only have to pay that once every three months.

If you lose your job, what happens to your health insurance?

Health insurance continues with no change if you lose your job. We do know very well that people who become unemployed are at an increased risk of becoming ill, and therefore becoming unemployed is about the worst time to lose health insurance. So therefore, everyone who loses a job remains in exactly the health insurance system that he is in.

German insurance plans actively compete among themselves for customers, even though they're not allowed to make a profit. So what's in it for them?

Sickness funds do not want to perish. They want to survive and grow, and the management is better paid if the sickness fund is growing. So I think the German health care system is a nice third way between a for-profit system, on the one hand, and let's say, single-payer system on the other hand.

It all sounds good to me. But how does the German system compare with ours? To get a U.S. view, I went to McGury's Cafe in the former East Berlin to meet Mike McGury, an American whose been living in Germany for six years.

Good to see you. It's been since Kladow. Wow, I love the new bar. It looks great. [speaks in German] [laughs] That's all the German I know. I want a big beer.

Oh, that's all you need! [laughter]

Do you ever have to go to the doctor? I mean, you've used the health care system?

Oh, absolutely.

Yeah. And what do you think? How would you rate it?

Top notch.

Oh, really? How come? What's good?

You have many different choices, and the cost is a fraction of what is covered in the States. Most of your prescriptions are covered with very, very small co-pays.

And how's the quality? I mean, do you think you're getting good health care here?

Excellent. Actually, I see no difference as far as quality goes between here and when I was in the States.

Really?

Yeah.

Surveys show Germans are satisfied with their health care. The system is also efficient. Medical providers and sickness funds negotiate standard prices, and this cuts administrative costs. They're only around 6 percent. That's a quarter of what they are in the U.S. And drugs are a bargain here, too.

The same drugs are way cheaper in Germany than in America because, obviously, if all sickness funds negotiate with the drug companies for a single price, then the market power of the sickness funds is fully used.

Every year, the sickness funds also negotiate standard prices with medical providers. And just as in Japan, some of these doctors feel undervalued and underpaid. Professor Detlev Ganten is chairman of Berlin's giant Charite Hospital.

So do you think your hospital is paid enough for the services it provides people?

No. As I mentioned, it's not being paid enough because we are providing very expensive care, a university hospital. So we have to economize enormously within the university system also.

An American hospital that felt it wasn't getting enough money for its services would raise prices. Could you do that?

No, we cannot do that. These prices are negotiated every year and this is done by states. So within Berlin, all the hospitals get the same kind of DRG re-compensation. We cannot raise our prices.

By U.S. standards, doctors who work in hospitals here are not paid very well. A 35-year-old might earn about $80,000 a year, about half of what he'd earn in the U.S.

It's not a high salary, and people correctly complain because they work not 8 hours, they work 12 hours, 14 hours, 16 hours, and sometimes seven days a week. And I think they deserve more.

Dr. Christina von Kockritz also feels shortchanged by the system. A family doctor makes around $120,000 a year, about two thirds of what she'd earn in the U.S. But then, she has a lot lower overhead. Her malpractice premium is just $1,400 dollars a year, about a tenth of what she would pay in the U.S. And medical school didn't cost her a penny.

(의사의 수입이 단적으로 "일년에 얼마를 버느냐"가 중요한 것이 아니라는 것. 독일의 경우처럼 의과대학을 졸업할 때까지 학비는 얼마나 들며, mal practice insurance는 어느 수준이고, 그 나라의 1인당 GDP 대비 얼마나 버느냐 등이 고려되어야 함.)

In America, we have an image of a doctor as a pretty rich person, who drives a Lexus to the country club and takes vacations in Majorca and stuff like that.

It be like this in Germany until I think '80s, the '80s, perhaps '90s, but it's changed in the mid of '90 years. So your doctor normally has a small car today. [laughter] But he still goes to Majorca.

Still goes to Majorca, yeah. And skis in St Moritz?

No. [laughter]

(여기서도 궁극적인 문제가 제기된다. 과연 의사는 얼마의 돈을 벌어야 하나?)

But a lot of doctors aren't laughing. In March of 2006, they felt sufficiently angry to stop work and take to the streets in the heart of Berlin. Dr. Christina was one of them. She marched three times that spring.

I think about 18,000 or 20,000 doctors, and doctors don't usually demonstrate. But nothing changed.

For Americans, there's nothing particularly foreign about German health care. You get health insurance through your employer and the company makes you pay for it. And the coverage is great. They got mental, they got surgical, they got dental. If your doctor says you're tired, the health insurance pays to send you to a spa. And the Germans have made this work. They provide universal coverage for a lot less money than we do. They did it by taking the profit out of health insurance, and they also pay doctors a lot less than we do. I think there's a lot here that we could learn from.

In just three countries, I've picked up lots of ideas. The Brits pay no doctor bills and have great preventive care. In Japan, there's no waiting time and doctors still make house calls. In Germany, insurance companies compete for business, even though they can't make a profit.

What if you could pick and choose the best ideas from around the world? Well, that's exactly what one small Asian nation did.