Active ageing and European health care systems (WP4): country report Germany

Abstract

"The report deals with the health system and health care system in Germany and the way it relates to active ageing. 'Health care system' is understood here as the system of medical care which sets in when an illness has already occured. 'Health system', in turn, encompasses preventive measures which aim at a change of health behaviour, measures which address the physical and social environment (e.g. road safety, food safety and workplace safety) and the accessibility of different spheres of life to all people, also to those ill and with impaired mobility. The broader concept of health system encompasses the idea of 'prevention focused on circumstances' versus 'prevention focused on behaviour' used in German health policy discussion. 'Prevention focused on circumstances' aims at designing healthy living and working conditions. According to EK (2002), this goal goes beyond the scope of health policy alone. In contrast, 'prevention focused on behaviour' tries to improve the health status of the population and to diminish morbidity by influencing health behaviour of people (EK 2002). Throughout the whole report, issues pertaining both to the broader concept of health system and to health care alone will be raised. In chapter 2, the demographic features of Germany will be outlined - the age composition of German population, old-age and youth dependency ratio, life expectancy and healthy life expectancy. Chapter 3 deals with the health status of the population. In this chapter, measures related to the concept of 'health' as absence of illness or injury will be presented next to measures of self-assessed health status. That way, a concept which belongs to the realm of health care will be contrasted with a concept which pertains to the health system. Chapter 4 deals with the main risks to health. In section 4.1., factors which may cause fatal diseases are described, like smoking prevalence and consumption of alcohol. Section 4.2. then turns to main causes of mortality in Germany and shows age-specific disease patterns. Subsequently, the occurence of the myocard infarct as one of the most important causes of death in Germany is analysed in more detail. Chapter 5 turns away from statistics and concentrates on the organisation of health care in Germany and on the functional principles of the health care system. In this chapter, possible problems inherent in the system are depicted which have been (or will be) addressed by health reforms. Section 5.4. highlights some reform plans and enacted reforms within the German health system from the point of view of the interviewed public health experts. The experts analysed the possible effects of those reforms on active ageing and on older people. Chapter 5.4. deals with the much-debated subject of health care rationing in Germany. Chapter 6 is the concluding section. It presents the main obstacles and chances for active ageing. This chapter again draws on the interviews." (excerpt)