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Article
January 27, 1997

The German Health SystemLessons for Reform in the United States

Author Affiliations

Department of Internal Medicine Madigan Army Medical Center Tacoma, WA 98431 The opinions stated in this review reflect those of the author and should not be construed to represent, in any way, those of the US Army or the Department of Defense.

Arch Intern Med. 1997;157(2):155-160. doi:10.1001/archinte.1997.00440230021004
Abstract

AS US HEALTH care policymakers struggle with issues of access, quality, and cost, it is worthwhile to study the health systems of other nations to consider including successful elements in our programs.1 The German health system may be a potential template, having achieved almost universal access, high quality, and free choice of physicians at a cost of only 8% of the gross domestic product. The Germans also have managed to control growth more successfully than any other industrial nation, with health care expenditures increasing only 2% from 1980 through 1990.2,3 In contrast, the United States has between 39 million and 52 million uninsured citizens,4,5 spends about 14% of the gross domestic product on health, and has experienced growth 33% greater than the increase in national income.6

HISTORY OF THE GERMAN HEALTH SYSTEM  Like every system of health care, the roots of the German system can be

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