This paper examines the effect of the dual health insurance on medical care in the outpatient sector, which stakeholder groups are still affected in addition to patients, and what the ethical outcome is. The dual health insurance system consists of statutory health insurance (SHI) and private full health insurance (PHI). About 72 million people in Germany are covered by one of the 110 statutory health insurances and around 9 million by the private sector. In 2016, a total of around 3565 billion euros were spent for healthcare. Outpatient treatment in doctors' practices accounted for 14.9% of this total.
Different research papers has shown, that the waiting time for a treatment is an indicator to measure imbalance access to health services. In two reports, different waiting times for SHI and PHI insured persons at a doctor's appointment could be determined. The length also depends on the distance to the end of the quarter, which is due to different rates paid to the doctors.
This unequal treatment was considered from an ethical point of view from the point of view of Utilitarianism and Kantianism. Both legitimize this procedure, but it must be questioned whether a fundamental change would not be more beneficial. However, the different access to health care does not represent a lower quality of medical treatment. Recent studies have shown that SHI insurants even receive the better benefits and that there is only a difference in service.
Table of Contents
1. Introduction
2. Morals and Ethics
3. Utility-based ethics by Bentham and Mill
4. Kant's duty-based ethics
5. The German health insurance system
6. Statutory health insurance vs. private health insurance
7. Different access for outpatient care
8. Conclusion
9. References
Research Objectives & Topics
This academic work explores whether Germany's dual health insurance system creates an imbalance in healthcare access. By examining outpatient care through the lens of utilitarian and Kantian ethics, the study investigates how insurance status influences treatment and resource allocation.
- Analysis of the German statutory and private health insurance dual system.
- Ethical evaluation using utilitarianism (Bentham and Mill) and Kantian ethics.
- Investigation of differences in waiting times and medical service access.
- Critical review of physician billing incentives and the quality of care.
Excerpt from the Book
Different access for outpatient care
It is regularly said that SHI insured persons have a less favourable access to health services than persons with private health insurance. But how does this look? On the one hand, people with private health insurance receive a more comprehensive diagnosis, especially in the outpatient sector with the same disease status. This is the result of the fact that PHI often pays more than double for the same medical services as SHI. This difference brings every doctor into a conflict of interest.
Regardless of the fulfillment of the patient's well-being as the primary goal, doctors develop secondary goals such as higher service, faster appointments and more complex diagnostics (Jörg, 2015, p. 14). At the end of a therapy, the doctor informs the SHI patient, but usually does not provide extensive information. In addition, the duration of the consultation is often shorter than with a PHI patient.
Summary of Chapters
Introduction: Provides an overview of the dual health insurance system in Germany and outlines the debate surrounding fair treatment and resource allocation.
Morals and Ethics: Defines fundamental concepts of morality and ethics to establish a framework for the subsequent philosophical analysis.
Utility-based ethics by Bentham and Mill: Explains the utilitarian approach, focusing on the maximization of welfare and the efficient allocation of resources.
Kant's duty-based ethics: Details the categorical imperative and the ethical principle of treating individuals as ends rather than means.
The German health insurance system: Traces the historical development and current structure of the German dual insurance model.
Statutory health insurance vs. private health insurance: Compares the functional and financial differences between statutory and private insurance sectors.
Different access for outpatient care: Analyzes empirical evidence regarding waiting times and the impact of billing differences on the doctor-patient relationship.
Conclusion: Synthesizes findings, emphasizing that while service differences exist, the overall quality of medical care remains high across both insurance types.
Keywords
health-insurance-system, outpatient-care, utilitarianism, kantianism, ethics, SHI, PHI, patient access, medical treatment, waiting times, healthcare economy, billing modalities, physician ethics, diagnostic services, welfare
Frequently Asked Questions
What is the core focus of this research?
The research examines whether the dual health insurance system in Germany creates an ethical imbalance regarding access to outpatient medical care.
Which ethical frameworks are used to analyze the topic?
The work utilizes utilitarianism, as proposed by Bentham and Mill, and Kantian duty-based ethics to evaluate the legitimacy of different treatment outcomes.
What is the primary research question?
The study investigates whether the dual insurance system leads to unequal treatment and if such disparities are ethically justifiable.
What methodology is applied in this study?
The author employs a literature-based ethical analysis combined with an overview of empirical findings related to healthcare economics and patient waiting times.
What does the main body of the work cover?
The main body covers the theoretical ethical foundations, the structural history of the German health system, and a detailed comparison of SHI and PHI billing and access practices.
Which keywords define this academic work?
Key terms include health-insurance-system, outpatient-care, utilitarianism, kantianism, ethics, SHI, PHI, and medical quality.
How do different billing systems influence doctor-patient interactions?
The text explains that the higher profitability of PHI patients can lead doctors to favor this group through shorter waiting times and more extensive diagnostics, creating a potential conflict of interest.
Does the author conclude that the German system provides lower quality care to SHI patients?
No, the author concludes that while service levels differ, recent studies suggest there is no significant reduction in the quality of medical treatment or health outcomes for SHI patients.
- Arbeit zitieren
- Benjamin Heppner (Autor:in), 2019, Does the dual health insurance system produce a imbalanced access to health provision?, München, GRIN Verlag, https://www.grin.com/document/480595
