history of german health insurance before 1945 - the boring reality

Nearly everyone residing in Germany is guaranteed access to high-quality comprehensive health care. Statutory health insurance (Gesetzliche Krankenversicherung—GKV) has provided an organizational framework for the delivery of public health care and has shaped the roles of payers, insurance or sickness funds, and providers, physicians, and hospitals since the Health Insurance Act was adopted in 1883. In 1885 the GKV provided medical protection for 26 percent of the lower-paid segments of the labor force, or 10 percent of the population. As with social insurance, health insurance coverage was gradually extended by including ever more occupational groups in the plan and by steadily raising the income ceiling. Those earning less than the ceiling were required to participate in the insurance program. In 1995 the income ceiling was an annual income of about DM70,00 in the old Lnder and DM57,600 in the new Lnder .

In 1901 transport and office workers came to be covered by public health insurance, followed in 1911 by agricultural and forestry workers and domestic servants, and in 1914 by civil servants. Coverage was extended to the unemployed in 1918, to seamen in 1927, and to all dependents in 1930. In 1941 legislation was passed that allowed workers whose incomes had risen above the income ceiling for compulsory membership to continue their insurance on a voluntary basis. The same year, coverage was extended to all retired Germans. Salespeople came under the plan in 1966, self-employed agricultural workers in 1972, and students and the disabled in 1975.

The 1883 health insurance law did not address the relationship between sickness funds and doctors. The funds had full authority to determine which doctors became participating doctors and to set the rules and conditions under which they did so. These rules and conditions were laid down in individual contracts. Doctors, who had grown increasingly dissatisfied with these contracts and their limited access to the practice of medicine with the sickness funds, mobilized and founded a professional association (Hartmannbund) in 1900 and even went on strike several times. In 1913 doctors and sickness funds established a system of collective bargaining to determine the distribution of licenses and doctors’ remuneration. This approach is still practiced, although the system has undergone many modifications since 1913.

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