# data[].attributes.body
1. U.S. Census Bureau quickfacts. United States Census Bureau. (n.d.). Retrieved April 12, 2022, from https://www.census.gov/quickfacts/fact/table/US/PST045221
2. United States . The World Bank Data. (n.d.). Retrieved April 12, 2022, from https://data.worldbank.org/country/united-states?view=chart
3. Centers for Disease Control and Prevention. (n.d.). Data & Statistics. Centers for Disease Control and Prevention. Retrieved April 12, 2022, from https://www.cdc.gov/DataStatistics/
4. About the United States. USAGov. (n.d.). Retrieved April 12, 2022, from https://www.usa.gov/about-the-us
5. U.S. Department of Labor. United States Department of Labor. (2022, April 8). Retrieved April 12, 2022, from https://www.dol.gov/

6. “GERMANY | Summary.” Columbia Public Heath. Columbia

University, 2019. https://www.publichealth.columbia.edu/research/comparative-health-policy-library/germany-summary

7. OECD/European Observatory on Health Systems and Policies (2019), Germany: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels. https://www.euro.who.int/__data/assets/pdf_file/0005/419459/Country-Health-Profile-2019-Germany.pdf

8. National health expenditure data. CMS. (n.d.). Retrieved April 16, 2022, from https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical

9. Overview of the US healthcare delivery system. (n.d.). Retrieved April 16, 2022, from https://samples.jbpub.com/9781449615192/69840_CH01_Niles.pdf

10. Summary - U.S. health in international perspective. (n.d.). Retrieved April 16, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK154469/

11. The Health Care Delivery System - NCBI Bookshelf. (n.d.). Retrieved April 16, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK221227/

12. Mirror, mirror 2021: Reflecting poorly. Commonwealth Fund. (2021, August 4). Retrieved April 16, 2022, from https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly

13. Trends in health care spending. American Medical Association. (n.d.). Retrieved April 16, 2022, from https://www.ama-assn.org/about/research/trends-health-care-spending
14. Health expenditure. Federal Statistical Office. (2019, August 15). Retrieved April 16, 2022, from https://www.destatis.de/EN/Themes/Society-Environment/Health/Health-Expenditure/_node.html
15. Edwards, E., & Dunn, L. (2019, June 30). Is Germany's health care system a model for the U.S.? NBCNews.com. Retrieved April 17, 2022, from https://www.nbcnews.com/news/amp/ncna1024491
16. Girvan, G. (2021, July 28). Germany: #3 in the 2021 world index of healthcare innovation. Medium. Retrieved April 17, 2022, from https://freopp.org/germany-freopp-world-index-of-healthcare-innovation-84d380091cb7
17. Gaille, L. (2021, February 2). 19 pros and cons of German Healthcare System. Vittana.org. Retrieved April 18, 2022, from https://vittana.org/19-pros-and-cons-of-german-healthcare-system

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Values

Germany’s healthcare system values quality, safety, provision of care, and health resources. However, because the system's structure tends to be fragmented, it is difficult to get a comprehensive picture and assessment of the health care system as a whole. There are some weaknesses in the system's individual parts. Because of the separate systems and programs, it is challenging to gather an accurate evaluation of the system as a whole and create measurable and appropriate goals. Applying a systematic evaluation would allow Germany to improve its healthcare costs and quality of care. ⁷

Economy

In Germany, their health expenditure is 11.25% of its GDP. The healthcare expenditures and benefits of the SHI system contribute to Germany’s strong economy. This is due to healthcare funding being reliable on wage-related health insurance contributions. ⁷

Government

Germany’s healthcare system has three levels of government: the federal, the state (Länder), and self-governance bodies.

At the federal level, the Federal Ministry of Health manages the policies for the hospital administration.

At the state level, the Länder oversees the planning and financing of the hospital.

The self-governance bodies and the Federal Joint Committee govern “...translating legislative objectives into specific regulations,” such as the social health insurance (SHI) funds. ⁷

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United States - Values, Economy, & Government

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United States - Values, Economy, & Government

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The US constitution establishes a federal democratic republic form of government

Each state's government has different rules and regulations regarding some healthcare topics

Healthcare regulations are enforced by federal, state, and local governments

State governments are in charge of local public health departments

The US is a mixed economy

Current unemployment rate: 3.6%⁵

2020 median household income: $67,521¹

Federal minimum wage: $7.25⁵

Many states have a higher minimum wage

The United States expensive healthcare system can lead to questions regarding how the government values its citizens

People are unable to afford healthcare despite the true need for it

Medication prices continue to increase even when people are depending on these medications to live

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Population: 83.9 million.
GDP: 3.846 trillion USD.
Health Expenditure in 2019: 11.25% of GDP.
Major ethnicities in Germany include

German (80%)

Other European (12%)

Turkish/Kurds (3.5%)

Asian (2%)

Other (2.5%) ⁶

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Population: 331.89 million¹

GDP: 20.9 trillion²

In 2020, around $4 trillion was spent on healthcare.²

Major racial groups in the US¹

White 60.1%

Hispanic 18.5%

Black 13.4%

Asian 5.9%

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Fertility rate²

1.7 births per woman

Life expectancy²

Men: 76.4 years

Women 81.4 years

Infant mortality²

5.4 per 1,000 births

Child mortality²

6.3 per 1,000 births

Maternal mortality²

19 per 100,000 births

Prevalence of obesity³

42.4%

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Fertility Rate: 1.6 live births.

Life Expectancy: female 84 and male 82.

Infant Mortality Rate: 2.1 deaths per 1,000 live births.

Child Mortality Rate: 2.6 per 1,000 live births.

Maternal Mortality: 7 deaths per 100,000 live births.

Prevalence of Obesity: 23.60%. ⁶

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Germany - Leading Causes of Death & Major Health Issues

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Germany - Leading Causes of Death & Major Health Issues

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Germany's leading cause of death is ischaemic heart disease (1:10 deaths).

Other significant causes of death include premature deaths, circulatory diseases, specifically ischaemic heart disease, stroke, and lung cancer.

Some major health issues in Germany are diabetes, breast cancer, pneumonia, colorectal cancer and chronic obstructive pulmonary disease (COPD), kidney disease, and pancreatic cancer. ⁷

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United States - Leading Causes of Death & Major Health Issues

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United States - Leading Causes of Death & Major Health Issues

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Leading causes of death³

Heart disease

Cancer

Covid-19

Accidents

Stroke

Major health issues

Smoking³

12.4% of adults smoke

20.8% of adolescents grades 9-12 have used e-cigarettes in the last 30 days

Diabetes³

10.5% of population has diabetes

Hypertension³

47% of population has hypertension

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Financing

Germany is a universal multiplayer healthcare system.

In Germany, healthcare is financed by funds through mainly insurance premiums.

“SHI is financed primarily through mandatory income-related contributions deducted from employers and employees, and tax revenues.”

“PHI premiums depend on individual health risks. There are different payment systems in place for ambulatory service provision for patients covered under SHI and PHI, and treating PHI patients is generally much more profitable for doctors. This leads to inequalities, with SHI patients being exposed to longer waiting times than patients with PHI (National Association of Statutory Health Insurance Physicians, 2018).”

“The need to reform the payment system is currently one of the main topics on the political agenda.” ⁷

Insurance

Germany’s healthcare insurance is predominantly universal, which means all legal residents have coverage.

There are two types of insurance in Germany’s healthcare system: public social health insurance (SHI) and private health insurance (PHI).

In Germany, those with SHI are generally employees, while those with PHI typically have a higher income or are in a specific professional group.

The SHI system covers 87% of the population in Germany, while only 11% is under PHI companies. ⁷

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Germany utilizes a universal multi-payer healthcare system It encompasses both statutory health insurance for people who earn less than a certain salary, as well as private health insurance for those who earn more and choose to purchase their own. This essentially means that every German citizen is entitled to free healthcare. Free healthcare is provided by a small fee paid by each citizen every month, with a in hospital co-pay that is limited to a maximum yearly payment. However, if one can afford private healthcare that are able to. Private healthcare may entitle a more one on one approach to medicine, reducing the wait time, and allowing for a smoother medical visit.  ¹⁵

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Only major country that does not offer a universal healthcare program

The Affordable Care Act was created to make affordable health care more accessible

Public health insurance is funded by the government through taxes¹

34.8% of people with health insurance have public health insurance

18.4% have Medicare

17.8% have Medicaid

Private health insurance is usually more expensive and primarily provided by employers¹

66.5% of people with health insurance have private health insurance

8.6% of the population is uninsured¹

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United States - Healthcare Delivery System

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United States - Healthcare Delivery System

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Unlike many counties, the United States does not have a universal healthcare delivery system, and citizens are not entitled to routine and basic healthcare services.

Government sectors of healthcare

Medicaid and Medicare - Healthcare programs for elderly and poor.

Private sectors of healthcare

Private insurance where the individual pays a monthly amount for healthcare along with a deductible and co-pay.

Employer insurance 55% of private insurance.

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Germany- Quality of the Healthcare System

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Germany- Quality of the Healthcare System

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Although Germany’s healthcare system is the oldest in the world, being founded in 1883, they are ranked #3 in the World Index of Healthcare Innovation. This is due to an increase in fiscal sustainability and choice.

An increase in choice allows for the individual to chose where they get their care from, and how they get their care.

Where Germany fails is their lack of science and technology. Their lack of new equipment pulls their overall score down.

A direct effect of this was the vaccine rollout being botched.

Germany struggled to roll out their vaccine to the citizens.

When compared to all European countries, Germany still came in third, with its weakest links being technology, and quality.

Although quality was its lowest score relative to others.

Germany’s quality of care ranked significantly higher than most in all of Europe ¹⁶

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February 15th, 2018; Germany’s healthcare expenditure exceeds €1 billion annually

This marked the first time public health expenditure reached this level.

April 16th, 2021; Germany’s healthcare expenditure exceeds €400 billion in direct response to COVID-19

April 7th, 2022; Germany’s healthcare expenditure exceeds €440 billion

Germany constantly re-evaluated the threat of COVID-19 and increased the amount of money delegated to the countries public healthcare system in direct response.

Due to COVID-19 the countries expenditure per inhabitant has increased dramatically. From approximately €11, to now €5,298 which is 13.1% of the countries GDP¹⁴

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Although the United States spends more money per capita on healthcare each year than any other country, it is ranked poorly in quality of healthcare. In fact, in a study comparing the quality of healthcare in 11 different countries, the United Sates came in at #11 being last place.

Unfortunately, higher spending doesn't necessarily correlate to higher quality of care

The US does not have high access to care, and many times people are denied coverage for a plethora of reasons by their insurance company

The United States also ranks low in quality of healthcare outcomes, meaning there is a high rate of infant mortality and a relatively low life expectancy among many other shortcomings.

The US does show good quality in preventative care in areas such as women's health and vaccinations

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In 2020, healthcare spending reached $4.1 trillion ($12,530 per person)

Medicare spending reached $829.5 billion, taking up 20% of the national health expenditure (NHE)

Medicaid spending reached 671.2 billion, taking up 16% of NHE

Private health insurance declined to $1,151.4 billion, consuming 28% of NHE

Out of pocket spending declined to $388.6 billion, which is 9% of NHE

National health spending is projected to reach $6.2 trillion by 2028

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Germany- Benefits  of  Healthcare Systems

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Germany- Benefits  of  Healthcare Systems

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Although the medical system is touted as “free” it requires a payment from each citizen

A small fee of approximately €90/month is the usual rate for students

This doesn’t depend on health problems

After this payment, basic healthcare needs are met, and require no additional payment for health related expenses

This includes ambulance rides etc

This is a fear that Americans have, that all health care would be completely free, and lead to a “socialist” state

Germany’s healthcare system could be an inspiration

As stated in the disadvantages slide, German doctors typically do not prescribe addictive pain killers easily. While this may impact patients who need it, in the sense that they have to wait longer, it does lead to a lower amount of prescription painkiller dependent individuals

If one feels they need private health insurance to supplement the public plan, they can opt to purchase

This helps with more elective surgeries, and is common for dental care

Co-pays are extremely reasonable, with a maximum of €10/day in a hospital.

This again is mediated by a maximum yearly payment of €280 ¹⁷

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United States - Limitations of Healthcare System

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United States - Limitations of Healthcare System

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The US does not have universal healthcare.

Insurance coverage is limited and can be very costly.

Despite spending the most money on healthcare compared to other countries, there is a high rate of many health issues such as diabetes, heart disease, and obesity as compared to the west of the world.

The healthcare system has large disparities between income groups.

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Germany - Limitations of Healthcare System

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Germany - Limitations of Healthcare System

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Although healthcare is free, in many cases the healthcare provided is only what is deemed necessary.

This results in certain procedures, which may be necessary, but are too expensive not being paid for

This results in less fortunate people needing to pay out of pocket private medical fees

Doctors don’t make as much money

Medication prescription is harder to come by as Germany’s philosophy is to prescribe less addictive counterparts such as Tylenol before prescribing any opioid pain killers

Dental coverage is lacking, as the universal health care system doesn’t cover crowns etc ¹⁷

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United States - Benefits of Healthcare System

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United States - Benefits of Healthcare System

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You have many options of different levels of healthcare plans and coverage.

If you can afford premium healthcare, you will be provided with high quality doctors and modern technology.

Since we pay healthcare workers more than other countries, we have some of the highest level of skilled professionals.

Even if you cannot afford healthcare, you will not be denied emergency treatment.

There is minimal waiting time for healthcare.

There are adequate resources such as supples and medications for patients.