Rede bei der Transatlantic Health Conference am 21. Juni 2011 an der Universität von Minnesota in Minneapolis
Rede bei der Transatlantic Health Conference am 21. Juni 2011 an der Universität von Minnesota in Minneapolis Lieutenant Governor, Commissioner, Honorable Senators and Members of the House of Representatives, (Fr) Dr. Engel,
Ladies and Gentlemen,
It is a pleasure to join you here in Minneapolis today and to be part of the Transatlantic Health Conference. This year marks the eighth annual Roundtable hosted by the Center for German and European Studies in cooperation with Germany's Federal Ministry of Health. My sincere thanks to you and to your team, Dr. Engel, for this record of success.
All of us involved in health policy know how interesting the health sector can be to our fellow citizens. I'm sure you're all familiar with the following experience: you're at a social gathering and someone asks you what your line of work is. You've hardly had time to respond before being pounded by questions and drawn into involved discussions. Almost no other area of public policy impacts people so directly. Decision-makers in other policy areas might often wonder how to enhance their visibility in the public forum.
That's surely the least of our concerns as policymakers in the health sector. After serving as health-policy spokeswoman for my party in the Bundestag I know what I'm talking about. I should note - that while working in that capacity - I was also a member of the Bundestag's Budget Committee. That let me experience at first hand, all of the tension that can arise between health-care policy and fiscal considerations. Early last month I was then appointed Parliamentary State Secretary in our Federal Health Ministry. By no means, have I now changed sides. As you probably know, the German constitution provides for our Federal Chancellor – currently Dr. Angela Merkel – to be chosen not by the direct vote of the people, but indirectly through the majority of their representatives in the Bundestag.
Institutional rivalries between the legislative and the executive therefore do not arise in Germany and we count that as a blessing. The federal government is built on the majority in the Bundestag and that support sustains the executive branch in its ability to act. But let me get back to the more specific topic of health policy. I'm sure you will agree that a forward-looking health policy today must transcend national borders. We increasingly have to think of health in global terms. And, when doing so, we have to keep the following points in mind. First: Health is a human right. Citizens rightly expect governments to keep them safe from internal and external security threats. In no less measure, they also expect governments to take responsibility for protecting their health and for providing universal access to health care. At the World Health Assembly in Geneva only a few weeks ago, the international community of states once again committed itself to achieving that objective – I quote: "to aim for affordable universal coverage and access for all citizens on the basis of equity and solidarity, to plan the transition of their health systems to universal coverage."
The resolution was put forward by Germany. And it was also embraced by the United States. The resolution also provides for Director-General Chan to propose, that this topic be submitted for consideration by the United Nations General Assembly. The second point we must always consider is that communicable diseases such as HIV/AIDS, malaria, and tuberculosis do not stop at national borders. Today's transport and transportation systems facilitate the spread of pandemics around the globe at a hitherto unprecedented pace. Combating them requires, intensive cooperation by the community of states. Non-communicable diseases also constitute a global challenge. We have to recognize the fact that the disease burden of our population is not the same as it was when our health systems first evolved. As our societies become wealthier and our citizens older, chronic illnesses such as diabetes, coronary and cardiovascular disease, and cancer are on the increase. These diseases are linked, in part, to our lifestyle.
To respond, we cannot simply continue along the trodden path of the further mechanization of medicine. We have to learn to rely much more on prevention, to motivate patients to do more for their own health, and to reinforce their sense of personal responsibility and involvement. We must develop a locally accessible, low-threshold, multi-disciplinary supply of high-quality but low-cost forms of care. The third point we have to keep in mind is, that medical knowledge is global, as are the demands on medical professionals. The pace and dimensions of medical progress are enormous. Worldwide, there is a growing demand for health services – also as a result of our ageing societies. Suppliers of medical technology and pharmaceutical products operate worldwide.
Medicine has become a globalised market and is now one of our economy's most important sectors. Our task is therefore, to manage the difficult balancing act between having a health care system that is more patient-centered and focusing on job protection concerns. Fourth: Health care is personnel-intensive. We cannot expect to achieve productivity gains in the health sector anywhere like those that are possible in industry. Prices for health services will thus continue to rise faster than in the overall economy. The problems entailed in financing the health sector are therefore very likely to increase. Nevertheless, we should not lose sight of the fact that the difficulties facing the industrialized countries of the West are small by comparison with those of the rest of the world. For the disease burden on the population in the world's poorer countries is significantly higher.
And those countries of course have even fewer financial resources available to cope with their problems than we do. That doesn't mean we can sit back and be satisfied with the status quo. We have to continue to improve our health care systems. And yet, we must always remember that – despite our difficulties – we enjoy a privileged position by international comparison. If we can't solve these problems, who can? No matter how different our respective systems, we all face common challenges. We should therefore make use of every opportunity to learn from one another.
Just for a second, let me take you back to the last World Health Assembly. At that time, the participating governments agreed unanimously, and I quote: "to share experiences and important lessons learned at the international level for encouraging country efforts, supporting decision-makers, and boosting reform processes." That is exactly the purpose of our Transatlantic Conference on Health Care here in Minneapolis. For a number of years now, the Transatlantic Health Forum has served as a marketplace for exchanging ideas. I am, therefore, only too happy to be here and report on the current status of Germany's reform efforts in the health-care sector. You may already know, that everyone who resides in Germany is covered by health insurance.
Health insurance is mandatory in my country. And the provision of health care in the Federal Republic is organized and financed by our statutory and private health-insurance funds. We have no need for special programs, such as health-insurance plans for the elderly or for low-income households. Our system provides all of our people with guaranteed access to medical care. The challenge is to ensure that the system's quality continues to improve while its costs are kept from escalating. Germany has done a good job of weathering the economic crisis. Our social security systems, including health care, have emerged undamaged.
No one lost insurance coverage and no one had to fear being deprived of care. However, a huge deficit in the statutory health-insurance system confronted the Christian Liberal Coalition when it took office just over two years ago. The funding shortfall amounted to double-digit-billions of Euros. We acted without delay to adopt a series of measures to put the system back on sound financial footing.
• We had to raise the general contribution rate (equivalent to an insurance premium)
• and increase government subsidies to the Federal Health Fund.
• We also called on service providers to contribute their share, particularly in the form of discounted pharmaceuticals – a measure you've also applied here in the U.S. The measures we enacted , have proven to be right on target. Once the financial stability of the health insurance system had been restored, the coalition government began to undertake the necessary structural reforms. Our strategy combines sustainability, free choice for patients, planning security, competition, transparency, self-employment, and social security. Its aim is to clear away the clutter of bureaucratic constraints in the health-care system.
• Government's job is to create the framework for providing requisite insurance coverage in the event of sickness.
• Citizens should have the freedom to choose the type of coverage they want. We seek greater efficiency through more competition at all levels. Our first structural reform measure was to re-organize the pharmaceutical market. Since the beginning of the year, the responsible organizations and companies have been required to agree within a period of 12 months on a reimbursement price for every pharmaceutical, introduced with new active agents. The price has to be in keeping with both - the general and the additional benefits offered by the product. Our Federal Joint Committee (of Physicians and Health Insurance Funds) is tasked with drawing up a benefit assessment for new pharmaceuticals based on a dossier submitted by the manufacturer.
That creates • transparency about the added benefits of the respective pharmaceutical, over and above those of standard therapies.
• It also identifies the patients who stand most to profit,
• and the extent of the expected benefit. The result is a thorough restructuring of Germany's pharmaceuticals market. We expect to have the first benefit assessments on the table by the end of this year and the first results of price negotiations are anticipated for the second half of next year.
We can't yet say whether the new system will meet legislators' expectations. The reforms demand a high degree of willingness for all of those involved to take on responsibility and cooperate constructively. We expect that our reforms will let us accomplish the balancing act of securing jobs in Germany while supplying patients with affordable pharmaceutical products. We will naturally be monitoring the further implementation of these measures very closely. Furthermore, we put together a solid foundation to finance our statutory health-insurance funds. We set employers' contributions at a fixed rate and, by doing so, de-coupled labor costs from health-care costs. That helps foster growth and employment in the long term. In future, any unavoidable increases on the expenditure side will now be financed by additional, non-wage-related contributions from the insured.
Financial autonomy and competition among health-insurance providers have thus been strengthened. We are currently working on a law to improve the provision of health care. It will give the insured greater freedom to choose their coverage in accordance with their individual needs. We are providing incentives to encourage more doctors to set up practices in under-served regions. nd we will create the prerequisites for hospitals and non-hospital physicians to improve their collaboration when treating patients. We want to ensure that highly-specialized, out-patient medical services will be provided at equal quality and for equal reimbursement by both hospital and non-hospital panel doctors. This counts as another dramatic improvement in the German health care system, since non-hospital doctors have previously worked in isolation from their hospital-based colleagues. Wherever possible, we plan to do away with excessive bureaucracy.
Another goal we have set ourselves for the current legislative period is to implement the necessary improvements in services provided to persons in need of long-term care. We also wish to see the establishment of a capital reserve for long-term care insurance to offset future needs.
The following point is of vital importance to me, so bear with me for repeating it:
Our reforms focus
• on the goal of greater competition – or more market – in health care.
• Our objective is to roll back the government's bureaucratic influence and curb socialized medicine.
• We will be giving patients choices – choices about health-care opportunities and about insurance rates.
• Health-insurance providers will be given greater freedom to negotiate contracts. The exchange of know-how and experience with the United States is especially valuable to us in this context.
The United States in general and the University of Minnesota in particular are laboratories for testing new health management approaches and strategies. Germany has made use of your experience on diverse occasions in the past. A number of concepts originally adopted from the United States have already been introduced nationwide in Germany. One such example I'm sure you'll recognize is the DRG reimbursement method in hospitals. In turn, you might want to look at our experience with the system as a basis for further refining it here in the U.S.
All of you here today are specialists in the wide range of managed-care issues. I'm sure you have a wealth of experience and know-how to share. Let me take this opportunity to wish you interesting and stimulating discussions. I hope the time you spend exchanging new insights and ideas on how to improve health care in our countries will be both fruitful and enjoyable. Thank you for your kind attention!
