Health is a civil right, not a privilege. Humanitarianly it should equally reach to every human being. But in Bangladesh that’s not the case.
Bangladesh has made some advancement in the health sector only in this last decade. In the capital city Dhaka, there are some government hospitals along with privately owned hospitals with world class facilities. But there is a scarcity of qualified doctors, nurses and staff. Many doctors apart from working in government hospitals are also practicing in other expensive private hospitals. These doctors make up nearly forty percent of total doctors in Bangladesh.
The health system in Bangladesh is laced with the disease of corruption. The government hospitals often force the patients to give illegal fees. Especially, the people who are under the poverty line cannot even afford private treatment facilities in the private hospitals.
It was 1883, when Germany introduced their first Health insurance system. But Bangladesh is yet to introduce any health insurance system in the country even in 46 years of its independence.
There is no class discrimination in the German Health system. There are no doctor’s fee, from medication to operation are all free of cost. The premium for the health insurance is split in half with employer paying half of the premium and the employee paying the other half. The premium is directly cut from the salary. The premium for unemployed people and those who cannot afford are paid by the government. If the father or mother of the family or both is employed then the whole family is insured. Even today the world’s most ancient health insurance system is more than able to give the highest health service to the people. If anyone in Germany gets ill they just go to their family doctor and give their health insurance card to the doctor. Doctor treats the patient and prescribes medication. The patient simply then goes to the pharmacy and takes the prescribed medicines. The expenses for the consultancy and medications are directly paid by the insurance. The patient does not know anything about the expenses. Obligated by law, German health insurance system has become one of the most important institutions in the country. It has seen the four significant and eventful political eras of Germany and has been successful in keeping its basic principles intact, throughout the time span of three German Reich’s regime and neo political system in Federal Republic of Germany. Germany’s compulsory health insurance is one of the oldest pillars of German health system.
On June 15, 1883, the German Reich Chancellor Otto Von Bismarck, introduced this rule as the health insurance for workers. Since then, all workers and employed persons working in Germany are covered by this health insurance. Two-thirds of the health insurance were given by workers and one-third of the health insurance had to be carried out by the employers. Germany is the first country in the world to launch this health insurance system for the people of their country.
Since then, this health insurance has been expanded as the defender of health protection of the nation. At the beginning of this health insurance, only 10 percent of the population was covered by this health insurance. Today it stands at 99 percent quota.
The benefits included in the beginning of this health insurance are:
- Free treatment
- Medicines
- Therapeutic treatment equipment
- 50 percent of wages available from the third day to 26 weeks were found if ill
- The benefit of paying 20 times the amount of his wages after his death
- Women are given wages up to 4 weeks after giving birth to a child.
Hitler's regime (1933-1945), the rule of the Nazi Party of Germany, this health insurance system’s autonomy was abolished. After the Second World War, the Federal Republic of Germany was established.
After that, the health insurance was re-established in 1952 and it was reversed and passed back to autonomy.
This health insurance has always been improvised, keeping in mind the social, political and economic changes. The changes made in the 1970s are noticeable. The ailing pay act was introduced in 1970. Under this law, the employer is obligated to pay his workers and employees, when they are ill. This law constitutes workers and high-level employees in the same parcel. When the economic status of Germany was at the top in the 70s, this health insurance service was expanded. Services such as healthcare services, early diagnosis services etc were introduced.
In 1989, East Germany and West Germany joined together and the people of East Germany were brought under the Health Insurance Act of 1991.
How is the German health system operated?
I will try to explain how the German health system is operated.
German healthcare is a well-coordinated organization, autonomous and operated in collaboration with many organizations.
With the cooperation of the organization "Germany's health insurance" is conducted, I will try to give you a complete outline.
The "Health Insurance of Germany" is operated with the help of the organization:
• Various health insurance companies (government approved)
• Doctor - Dental Doctor Association
• Hospital Association
• Pharmacists Association
Various Health Insurance Companies (government approved)
The health insurance company's responsibility is to ensure the full medical treatment by providing health insurance to the people of the country. In order to perform these duties, health insurance needs to come in various agreements with a variety of associate institutions and organizations such as: Doctors - Dental Doctor Associations, Hospital Association, and Pharmacist Association. Every health insurance company does not own or do the contract itself but is done by the Co-operative Society of Health Insurance Company
Doctors - Dental Doctor Association
There are 17 Doctors - Dental Doctor Associations in the 16 provinces in Germany. All doctors, dentists and psychiatrists are compulsorily members of this association. This Doctor - Dental Doctor Association agrees with the members of the health insurance company cooperative company on behalf of their members.
All these members, the doctors, dentists and psychiatrists, provide services to the patients. They do not collect the bill directly from the patient for those services. Which means the patient does not need to pay the doctor's bill. They collect these bills from Doctors - Dental Doctors Association and it takes from various health insurance companies.
The mandatory legal health insurance companies in Germany put forward a specific amount of money for each regional insured Doctor - Dental Doctor’s Association. Doctor collects from this amount through the association as per the cost of treatment of the health of every insured person's family. There is no difference between small or big family in this case or the system. It does not matter or no body is counting how many times a family has taken a doctor's treatment.
Hospital association
The German Hospital Association represents the principal and regional organizations of various hospitals, such as towns and municipalities, churches, charities and other non-government organizations.
Hospital medical bills do not collect through Doctor - Dental Doctor Association like the doctors. Rather then that, the healthcare provider collects directly from the patient's health insurance company. This means, the patient does not have to pay his own bills here too.
Pharmacists Association
All pharmacies are compulsory members of this association. There duty is to provide medicines according to prescriptions prescribed by the physicians to the patients and inform the patients about the benefits and hindrances of the medicines before giving.
The pharmacist association deals with the health insurance companies cooperative organizations on behalf of their members. All members of the Pharmacist Association do not take bill from the patients. They collect the price of the medicines from the legal mandatory health insurance company of Germany through the Pharmacist Association. That is, the patient does not have to pay a medicine bill.
The service of "Germany's health insurance" is divided into three sections:
Outpatient Services Sector
It means, all German citizens in their own areas according to their own will can choose to doctors to ensure the care of her family. Germans calls the preferred doctor as their family doctor. If any member of the family becomes sick, they go to their trusted family doctor. If this family doctor thinks that the patient is suffering from something that he can not give treatment to, then he sends the patient to a specialist or to the hospital.
Hospital Services Sector
With the referral letter of the family doctor, the hospital admits the patient immediately and starts the treatment. All medicines are supplied from hospital to the patients in Germany's hospital.
Alas! In our golden Bangladesh’s hospitals, patients need to buy all medicines from outside the hospitals.
Rehabilitation Services Sector
If the patient is suffering from a complicated disease or undergoes a big surgery, in that case the patient is sent to the rehabilitation centre (Sanatorium) for cure and all expenses and carries are borne by health insurance.
The writer is a Bangladeshi
expatriate in Germany