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Health Care Cost, Quality, and Access Comparison of Germany and United States: Two University Cities

Oct 27, 2017 04:33PM ● By The Hood Magazine

By Dr. Carole South-Winter, Assistant Professor, Beacom School of Business, University of South Dakota and Kimberly Cleveland, MBA in Health Services Administration, Beacom School of Business

Two university communities in two different countries, one with the oldest health care system in the world while the other having the most recent health care policy reformation. While varying health care systems are in place, the two communities demonstrate similar latitudes and cultures. Graduate and undergraduate students participating in faculty-led research at University of South Dakota Beacom School of Business Health Service Administration survey the communities to test the attitudes given toward their respective health care system.


United States Health Care System

            A variety of factors shape the United States (U.S.) health care delivery system including cultural beliefs, values, technological advances, social changes, economic constraints, and political opportunism. The corporate era endures complications and bureaucracy with delivery silos, and America’s health care system continues to struggle with problems and dilemmas. Consumers are unaware of the actual cost of care and remain confused by insurance and charges. It appears the complexity of the health care system has become too challenging for many Americans.

Germany Health Care System

            Germany’s Bismarck model is rooted in the philosophy of national solidarity and is the oldest health care system model. Under this model of health care, workers and employers contribute to a social insurance system through a payroll tax proportionate to income.These create “sickness funds” that cover medical expenses. The objective of the Bismarck model is to protect German citizens from health problems by spreading the risk over the whole community.


            Students who participated in a faculty-led program to study health care in Germany conducted a survey with German residents on their perceptions of health care. A similar community in Midwestern U.S. was also surveyed. A total of 235 usable German responses and 219 American responses were collected to empirically test these perceptions.


            Table 1 compares the statistically significant difference at the 0.01 level in the average survey response of three items.

Table 1

A Comparison of Germany and U.S. Survey Results


            Three questions from the survey reveal concerning differences within these two communities regarding cost, access, and quality of health care. German respondents consistently scored their health care system much higher than American participants in these categories. These differences may be attributed to fundamental political platform differences and most recent economic factors. For instance, Germans in the surveyed area embrace socialistic views especially as it relates to education and health care. While Americans experience increasing costs and/or less coverage from their employer-based health care insurance.

            Access to health care in Germany presents no barriers to residents except geographic location. The public train system is efficient and convenient throughout Germany. Access in the U.S. can be difficult for a host of reasons. These include and, especially in rural areas, transportation to required services and/or lack of services. Also, Americans continue to suffer from moral hazard and a genuine lack of knowledge or desire to understand health care. Some argue this is a result of corporation’s profit margin mentality or the result of the American capitalistic political platform.

The behaviors of communities seeking health care services are the result of personally held opinions that may be rooted in culture. While the two communities provide similar latitudes, significantly differing attitudes on health care exist suggesting the U.S system could glean insight from Germany’s system. On a side note a predominate number of ancestors in this midwestern community had migrated from this Germany region; Black Forrest to Black Hills.