The German health care system works like all German mechanisms - precisely and with maximum efficiency. This is not surprising, because its principles of social equality and accessibility of medical care were established by the “iron chancellor” - Otto von Bismarck in the 19th century. The health care system in Germany is considered to be one of the best in the world today. The main principle that is at the heart of the German health care system is the principle of solidarity. Medical care should be accessible to all the population regardless of their financial status, while it should be funded by insurance premiums. Germany is the country in Europe in which there are two systems of health insurance Those, who earn more than 48 thousand Euros per year, have the right to take out insurance in private companies; 8,000,000 million people now use this right, which is more than 10% of the population. The rest are required to contact the state sick funds. The sick funds (Krankenkasse) are financed by payroll taxes, half the cost is paid by the employee, half the cost is paid by the employer. The average amount is 15.5% of total wages. The patient can receive outpatient or inpatient medical care in the context of such a policy. The family doctor (Hausarzt), as a rule, is the first doctor visited by the patient. It is like a therapist, if this doctor cannot help the patient, he gives a referral to a specialist. The specialist doctor can work alone or in a team with other specialists, thus forming entire medical centers. Doctors of related specialties, for example, an orthopedist and a general practitioner or a surgeon and a gynecologist, but not an ophthalmologist and gynecologist, can also work in one private office. There are no clinics in Germany as we used to see. There are private offices (Praxis). Outpatient care refers to private offices, also it may be sometimes administered in hospitals. The private office can be opened by any physician who has a certain specialization (Facharzt). The private offices, mostly arranged in standard, have several examination rooms, a waiting room and reception. Depending on the intended use, rooms are equipped with modern medical equipment (digital cardiographs to ultra-modern tomographs), which does not only help the doctor in his work, but also acts as a weighty argument in choosing a doctor. Offices are usually located in residential buildings on the first floor. A doctor in the private office is both an employee (as a physician), and a manager (as the owner of this office), and an entrepreneur (who provides certain medical services to the public), as well. Approximately 5% of all private practitioners have the right to treat their patients in hospitals (Belegarzt). For example, a surgeon may perform minor surgical interventions in his office, but the same doctor must carry out heavy interventions only in the hospital. After that, the doctor visits these patients once or twice a day, and other doctors working at the hospital should monitor these patients the rest of the time. Almost all patients’ expenses are covered by insurance. There are more than two thousand hospitals (Krankenhaus) in Germany. They can be divided into 3 categories State, Private, Charity. Charities usually slightly differ in their organization from private hospitals. The main difference is the source of funding. The quality of services in all types of hospitals is about the same, and most importantly, the patient has the right to choose independently a clinic for treatment without being tied to the region of residence. Clinics can be both highly specialized and multi- profile. All of them are united by one thing - they are equipped with the latest technology and, as a rule, with a fresh repair. Hospitals can provide more technological medical care than private rooms. If the hospital has a surgical profile, then it usually has at least three operating rooms, a CT scanner, an X-ray unit and, of course, an ultrasound scanner. Operations requiring prolonged anesthesia or further observation in the intensive care unit are always carried out in hospitals. There are usually 2 patients in one ward, hospital surrounding helps the patient to relax and recover quickly. In any hospital in Germany, patients are provided with four meals taking into consideration religious restrictions. All wards have a TV or mini computer with TV shows. Besides, patients can choose to have a single ward. The University hospitals are entitled with a special status, and they appear to be not only the centers of high-tech medical service, but also have enormous research potential. These clinics develops innovative methods of treatment, which gives hope to patients. Some University hospitals are so huge that they form entire medical campuses. The most of emergency care is provided by private practitioners in their offices. There are medical offices working day-and-night on weekdays and at weekends in all areas of the country. The patient needs to call a single on- call number of his city, where he will be told the address of the nearest on-call doctor. At night, however, the patient is sent to the hospital in search of medical aid. If the patient is in a critical condition or for some reason cannot move independently, emergency services are provided by the rescue service, but it should be noted that this situation must really be a life-threatening condition. The ambulance simply refuses to arrive in case of a high temperature and will recommend you to drink something fever-reducing and go to the nearest private office. The following phrase may become a motto of the ambulance service in Germany - if you can get to the doctor’s office or hospital yourself, you have no right to call an ambulance. the so-called medical rescuers (Rettungssanitäter) work on most ambulances (Krankenwagen),this corresponds to our paramedic. If the case is severe, a physician (Notarzt) arrives to see the patient; he provides first aid and decides on further hospitalization. In Germany emergency care is provided absolutely forevery one, regardless of the availability of health insurance (for example, illegal immigrants), but after the recovery the patient will receive a bill with a very unpleasant sum. Every tenth resident of the country works in the German health care system, the fact that indicates the high prestige of this industry. Only the best of the best can become doctors, due to high competition and deep selection of candidates. Therefore, in Germany the salaries of doctors are always in the top positions in the wage rating.

O A Babajanova

Voronezh N.N. Burdenko State Medical University

D A Povalyuxina

Voronezh N.N. Burdenko State Medical University

  1. Edwin Morley-Fletcher. Vouchers and Personal Welfare Accounts. Proceedings of the9 B.I.E.H. International Congress [Internet- resource] pdf/2002Morley-Fletcher.pdf(Date:12.11.2018).


Abstract - 9

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