Health insurance It is mandatory for citizens and long-term residents to enrol in a health insurance scheme. Two systems exist: a statutory system, governed by Book V of the Social Security Code (SGB V), and substitutive private insurance. The statutory system consists of over 100 sickness funds which are non-governmental, not-for-profit health insurances that compete amongst each other. Free choice exists as to which sickness fund to join. Around 86% of the population are covered by statutory sickness funds (Gesetzliche Krankenkassen – GKV) and around 11% by private health insurances (Private Krankenkassen – PKV). The remaining population is covered through special programmes for military members, police and other public-sector employees. 

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It is mandatory for citizens and long-term residents to enrol in a health insurance scheme. Two systems exist.

Civil servants, students, self-employed persons and freelancer1 can choose whether they enrol in a statutory or private health insurance scheme (75% remain in the statutory health schemes). All others (e.g. employees or pensioners) must belong to a statutory health insurance scheme unless they earn a yearly salary exceeding EUR 60,750 (2019), in which case they can choose to join a private health insurance scheme instead of a statutory one. The salary threshold allowing opting-out of statutory insurance is subject to yearly reviews and has been steadily increased in the last years. Nonearning dependents are covered by the statutory insurance schemes. Everybody, irrespective of their yearly salary, can complement statutory insurance with private insurance.

Contributions to the statutory health insurance schemes depend on income with caps on maximum copayments to prevent financial burden. Contributions to private insurance schemes are based on health status, age and gender. Private insurance companies are required to offer a basic rate commensurate with entitlements under the statutory health insurance scheme. During the first five years of their stay, EU citizens who have not worked in Germany and whose country of origin has not signed the European Convention on Social and Medical Assistance have no right to welfare benefits. A 2016 law (Leistungsausschlussgesetz) defines, instead, basic health entitlements (e.g. urgent medical and dental care and pain management) and facilitate repatriation of the person. EU citizens who work in Germany can participate in the statutory or the private health insurance schemes under the same rules as described above. Long-term care insurance Based on Book XI of the Social Security Code (SGB XI), all members of statutory sickness funds are automatically enrolled for long-term care insurance; privately insured persons are required to enrol in private long-term care insurance. Unlike benefits of the statutory health insurance, benefits of the statutory long-term care insurance are only available upon application and approval by the Medical Review Board, a joint operation by sickness funds and long-term care funds. Beneficiaries in need of care of more than 6-month duration are placed in one of five tiers depending on need; shorter care is provided through the statutory health insurance scheme. Beneficiaries can choose between cash benefits to purchase their own care (Pflegegeld) or a range of benefits in kind (Pflegesachleistungen) such as general care (Grundpflege), domestic help, support of carers and care equipment provided at home or in nursing homes. The Federal Ministry of Health is responsible for long-term care and it is funded through equal contributions of employers and employees. A public holiday was converted to a working day to offset employers’ additional costs for long-term care insurance. 

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Philippines

Senate Bill No 1896 will pave the way for all Filipinos’ inclusion in our National Health Insurance Program, either as direct or indirect contributory members. This means that all Filipinos can use the promotive, preventive, curative, rehabilitative and palliative health services they need, of sufficient quality to be effective, while also ensuring that the use of these services does not expose them to financial hardship. 

Our goal is to achieve full 100 percent coverage in the most expedient way possible, expand our health benefit package, and bring more doctors to remote communities.”

WHO’s global drive for UHC came at an opportune time to advocate and inform the consultation and drafting process of the Bill in the Senate during the second half of 2017. By that time the Bill had already passed the House of Representatives. In order to get it passed through the upper house, the Bill needed technical refinement to ensure that it was comprehensive, practical and feasible, and would eventually achieve universal health coverage.

WHO Philippines, in close liaison with the WHO Regional Office for the Western Pacific, gently steered the process in the areas of people-centred integrated service delivery and health financing, drawing on experiences from other countries and regions with positive UHC experiences. This included the UK’s National Health Service model, China’s model of devolved health service provision and PAHO’s expertise in service delivery networks in US-influenced health systems.