Comparing the German and American Health Care Systems

Group Photo

Quian Callender

MHSA ‘18, Health Management and Policy

In March, I traveled to Germany with a group of University of Michigan Health Management and Policy students to learn more about the German health care system and how it compares to the health care system in the US.

"Despite spending the most on health care in the world, the US falls significantly below other countries, like Germany, in terms of health outcomes," says Jasmine Oesch, a second year Health Management and Policy student. "It was important for me to go to Germany in order to learn about how and why this is happening—whether it was a structural insurance-based system issue, different priorities, etc."

The US-German Excursion was formed and led by Dr. Andreas Schmidt of the University of Bayreuth in Bayreuth, Germany. The seven-day excursion gave my classmates and me the opportunity to explore the topics of health policy, social insurance, and German sentiment of health and health care. We were joined by students from the University of Bayreuth, the University of North Carolina at Chapel Hill and the University of Missouri, which allowed for a cross-cultural dialogue with lasting impact. "Such learning opportunities should probably be made available to all students in health management and policy," says Jersey Liang, professor of health management and policy and global public health at Michigan Public Health.

"Opportunities for international collaboration such as these are critical for fostering discussions and understandings of what our own health system can improve on," reflects first year Health Management and Policy student Peter Geppert. "Not only were the learning experiences invaluable, but the relationships forged on this trip between members of my own program, other US programs, and the German program will last a lifetime."

We visited many different associations and agencies, including the Federal Union of German Pharmacy (ABDA) to get a sense of pharmaceutical use and pricing in Germany. "The pharmacist occupation is tightly regulated compared to the US," notes second year student Constance Yang. "A pharmacy must be operated by a pharmacist, and consumers need prescriptions for medications that are typically over-the-counter in the US." These differences in policies result in differences in utilization and cost between the US and Germany.

We learned more about the German concept of solidarity. The young pay for the old; the rich pay for the poor; the healthy pay for the sick; singles pay for families.

 We also visited the Federal Joint Committee (G-BA), the highest decision-making body of the joint self-government of physicians, dentists, hospitals and health insurance funds in Germany.

Outside of policy and insurance, we had the opportunity to visit two hospitals, Klinikum Kulmbach in the state of Bavaria and Charite in Berlin. Klinikum Kulmbach, one of 360 hospitals in Bavaria, is a 150-bed hospital with about 20,000 residents in its catchment area. Most notable was its human capital structure. The hospital only has one executive—a CEO— compared to more than a dozen C-level executives in American hospitals, on average.

We were also surprised to learn about the limited scope of nursing in Germany. "The way the workforce is structured is completely different," says first year student Andrea Arathoon. "Nurses are not specialized, and do not have different degrees and levels like in the United States."

Charite in Berlin was structured much like an academic medical center in the US, with 7,000 medical, dental, and nursing students and 16,000 employees. As a result of the 2008 financial crisis, Charite restructured its operating model similarly to US models with cost centers and digitalization.

We had ample opportunity to talk with German students and get their perspective on their own health system. We learned more about the German concept of solidarity. The young pay for the old; the rich pay for the poor; the healthy pay for the sick; singles pay for families. When we asked the German students their opinion on Germany solidarity, it was a principle that they truly believed and held as a value.

On the final day, second year student John Crist, along with students from the University of North Carolina and the University of Missouri, presented a student perspective of the US health care system to the director of Inpatient Reimbursement Strategy for AOK, one of the largest insurers in Germany. Students presented on the trends of the number of hospitals decreasing and the shift from volume to value in which quality of care and outcomes are increasingly important.

In reflecting on his experience in Germany, second year student John Crist says, "Immersing myself in the German health system challenged my assumptions about the way things should be done and helped me see the strengths of the US system. Seeing the differences in inputs and outputs helped me identify opportunities for improvement in both systems."

Left to right: Jersey Liang, Ling Hung, Jasmine Oesch, Peter Geppert, Quian Callender, Constance Yang, John Crist, and Andrea Arathoon outside the Reichstag building in Berlin

Left to right: Andrea Arathoon, John Crist, Peter Geppert, Jasmine Oesch, Constance Yang, and Quian Callender outside Charite, the largest Academic Medical Center in Berlin

John Crist (right) presenting, along with students from the University of North Carolina and the University of Missouri, on the US health system for the director of Inpatient Reimbursement for Germany's largest Social Health Insurance Fund

About the Author

Quian CallenderQuian Callender is an MHSA student in Health Management and Policy at the University of Michigan School of Public Health. His primary research interests are population health, health equity, and health informatics. Last summer Callender was an administrative intern at Hartford HealthCare, assisting with the development of the system's telehealth initiative. Callender previously worked at Cleveland Clinic and the National Institutes of Health. Callender was in the 2014 cohort of the University of Michigan Summer Enrichment Program. Prior to his graduate studies, Quian received a Bachelor of Science degree in Healthcare Management from the University of Connecticut.