A Comparison of German and American Health Care Systems

On May 18, 2012, the American Institute for Contemporary German Studies (AICGS) organized a lunchtime discussion of health care policy in the United States and Germany featuring AICGS/DAAD Fellow, Dr. Dirk Göpffarth. An economist by trade, Dr. Göpffarth works as the head of the risk adjustment unit at the German Federal Social Insurance Office (BVA).  The seminar was generously supported by the German Academic Exchange Service (DAAD) and the Robert Bosch Stiftung.

As an introduction to his presentation, Dr. Göpffarth provided justification for the prevalence of health care policy debate in the United States and Germany. With the forthcoming U.S. Presidential election and U.S. Supreme Court decision regarding the Affordable Care Act (ACA), healthcare stands as a highly contested topic of debate in the United States. In 2009, Germany adopted a mandate requiring all individuals to have health insurance; however, the government makes no attempts to enforce this law. The lack of enforcement leaves approximately 200,000 Germans uninsured.

Health insurance offers unique challenges to policymakers as it essentially functions as two separate markets, a market for short term care and a market for chronic illnesses. Furthermore, Dr. Göpffarth contended that health insurance markets perform poorly with regards to chronic care as citizens feel less inclined to protect themselves from improbable health risks. This reluctance emanates from the culture of a society, which Dr. Göpffarth emphasized plays an immensely important role in the success of health care.  In the United States, universal health care troubles some Americans who fear that individual mandates would infringe upon their personal liberties. In Germany, however, universal health care policy dates back to Otto von Bismarck. Bismarck issued an individual mandate for health care amongst blue collar workers in 1883. Despite this historical precedent, issues of health care quality, access and affordability have risen in prominence in Germany.

Dr. Göpffarth emphasized that to improve health care actors must collaborate to forge data-driven change. To this effect, he added that standardized costs of medical procedures must be ascertained; physicians, insurance providers, and patients must provide communicate with each other; and health care systems must emphasize not only equity, but efficiency.

After his presentation, those in attendance posed wide-ranging questions including subjects such as religion, paperless medical records, and internet security.  Dr. Göpffarth declared that the importance of data privacy does not preclude accurate data collection. With regards to medical records, Dr. Göpffarth expressed doubt in the cost-effectiveness of conversion to paperless systems. Furthermore, he underscored the unique complications each nation faces in creating health care policy. In conclusion, Dr. Göpffarth reiterated that coordination of information and adjustments based on objective data offer the greatest potential for improvement of care in the United States and Germany.


May 18, 2012