Moreover, in Germany, patients are responsible for keeping track of their annual co-payments. Once the burden limit is reached, they must apply to their health insurance provider to be exempt from further payments. This system is intended to raise patients’ awareness of healthcare costs and reduce unnecessary utilization. However, because it relies on self-reporting, there is a risk that those who lack information or organizational ability may not fully benefit from the system. In particular, designing systems that reduce the financial anxiety of seriously ill patients will become increasingly important in the future. At the same time, maintaining sustainability requires careful management of unnecessary outpatient visits and a review of treatments with low cost-effectiveness. What becomes clear from this comparison is the importance of preserving safety nets for the severely ill while aiming for efficient, reasonable operation of the healthcare system. Within limited financial resources, building a more effective delivery system may hold the key to future healthcare reform. Under Germany’s statutory health insurance (GKV), insured individuals are required to make co-payments for certain medical services. This statutory co-payment system is designed to encourage cost-conscious and responsible use of healthcare services based on one’s financial capacity. However, to ensure that individuals with illnesses or disabilities are not excessively burdened, the Belastungsgrenze (maximum burden limit) system is in place. Under this rule, no household is required to pay more than 2% of its gross annual income for medical co-payments. For patients with severe chronic illnesses, this cap is reduced to 1%. The burden limit is applied based on the economic capacity of the entire household. This means that the household income and medical co-payments of all family members living together are considered collectively. Deductions are applied for each family member, lowering the calculated income. Both Japan’s High-Cost Medical Expense System and Germany’s Belastungsgrenze share a common goal: to reduce the financial burden on patients and ensure access to necessary medical care. One major difference, however, is that Japan’s cap is applied on a monthly basis, and if patients obtain a certification in advance, their out-of-pocket payments are automatically limited at the point of care. In contrast, Germany’s burden limit is calculated annually, and patients must track their expenses and apply for reimbursement once the limit is reached. This reflects not only a difference in institutional design but also in how patients are expected to engage with their own healthcare costs. Japan’s system tends to be more passive for the patient, while Germany’s places more responsibility on the individual. In healthcare policy, the most important principle is ensuring that patients in need can access appropriate care without facing excessive financial strain. Japan and Germany pursue this ideal in different ways, each with strengths worth learning from.9 Germany’s Belastungsgrenze Comparison Between Japan and Germany
元のページ ../index.html#10