In this segment, we'll review the interaction between the building blocks that make up the German Health System. We'll review some of the outcomes that system produces and some of the challenges facing the German Health System. Let's begin with access to care. On this measure, Germany achieves almost 100 percent coverage. There are 99.9 percent of German citizens who have access to or have health insurance. There are approximately 79,000 people in Germany who for one reason or another do not have any form of health insurance. Remember, that figure in the United States it's 27 million. In addition to this, relatively few people report having difficulty in accessing care. That is, access to care is not just a formal measure, but the bulk of Germans report being able to access care when it's needed. So there are only 0.5 percent of the population who've reported having foregone needed medical care. We next move to a measure of quality. The measure of quality that we're using here is the number of deaths amenable to health care. This is an important measure of quality because it indicates the number of deaths that could have been prevented by the provision of better healthcare. This could either be by way of improved safety, or by way of ensuring that larger proportions of the population obtain access to recommended care. This graph refers to the measures of the amenable deaths to healthcare in the period 2004 and 2014. Each of these countries included in this graph has shown a significant improvement in the number of deaths amenable to healthcare. That is, the number of deaths amenable to healthcare is significantly diminished between 2004 and 2014. But we see that Germany has relatively high levels of deaths amenable to healthcare. Perhaps more importantly, Germany has showed a slower rate of improvement in the number of deaths amenable to healthcare than the United Kingdom. Both Germany and the United Kingdom have reduced the number of deaths amenable to healthcare at a faster rate than the United States. The performance of the German health system in relation to the quality of care represents a real challenge for stakeholders and for the system of self-governance. It represents a challenge for stakeholders including the sickness funds, doctors, and hospitals to find strategies for improving quality. Amongst other things, this will require attention to ensuring that healthcare providers and patients have access to information flows that are timely and relevant. One notable feature of this problem will be to improve the quality of care in a system that is marked by very high levels of utilization. The challenge then in Germany is how to improve the quality of care and improve the efficiency, the delivery of the health system. Let's move on to a consideration of population health outcomes. In general, the position for Germany is that in each of the relevant measures, it is above the OECD, but is closer to the OECD average than many other European countries. This again reflects some of the challenges for the German health system. That is, there are very high levels of expenditure on healthcare and very high rates of utilization, but a lack of apparent results in improving population health outcomes. So in this graph, we note that Germany has a life expectancy of 80.7 years, which is just above the OECD average, is well above that in the United States, but well below life expectancy in other European countries, including France and Spain. In relation to infant mortality, we see a similar pattern. Germany has 2.8 infant deaths per 1,000 births, which is well below the OECD average of 3.6 deaths per 1,000 live births. But we note that the rate of improvement of infant mortality in Germany is well below that of some other European countries, Finally, in relation to maternal mortality, we see a similar pattern. The number of deaths is measured as the number of maternal deaths per 100,000 live births. Germany has relatively low at six maternal deaths per 100,000 live births. It is below the United Kingdom and well below the figure for the United States. Note here that the World Bank uses all data to measure maternal mortality in the United States. But there are a number of European countries that have lower maternal mortality rates. So in each of these cases, we find that the German healthcare system produces a somewhat lower level of quality of healthcare and population health outcomes that are below of a high-income European countries. This is despite those European countries spending less money on their health systems. The challenge then for Germany is how to address this multidimensional problem includes both the question of efficiency, quality, and population outcomes. One way to achieve this is through changes within the self-governing system in Germany. One of the primary mechanisms introduced by Germany in the 1990s to achieve better outcomes was the creation of The Federal Joint Committee. The Federal Joint Committee operates at arm's length from The Federal German Government. It includes representatives of all stakeholders of the German Healthcare Sickness, including sickness funds, physicians, hospitals, and patients. The Federal Joint Committee is able to set targets for quality and other measures within the German Health System, and it is able to push a nudge stakeholders to take steps to improve outcomes. In a general sense, the role of The Federal Joint Committee is to be responsive to calls for improvement from within the health system and to be responsive to policies formulated by the German government. The challenges for The Federal Joint Committee to develop its capacity so that it is more responsible to those policies and expectations that are directed at improving the quality of health care, controlling the cost of healthcare, and improving population health. Some commentators have recommended that the German government, particularly the Federal government, become more directly involved in setting targets and implementing interventions designed to achieve those targets. This is problematic because it will involve the German government being more directly involved in the provision of healthcare services, and it will mark a movement away from the reliance on a self-regulating bounded form of governance to guide the health system. This is important because in the following segment when we review the health system in England, we'll see that the England healthcare system has responded to these challenges in a different way.
