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Busse R

In: European Observatory on Health Care Systems (ed.) Health care systems in eight countries – trends and challenges. London: London School of Economics, p. 47-60





The German political system is characterised by federalism (sharing of power between Länder and the federal government) and corporatism. The responsibilities for health reflect this. They are shared between the federal government, the Länder and corporatist bodies (representative bodies of the professionals, providers and the insurers). The health care system is predominantly funded through social health insurance contributions. Ambulatory care and hospital care have traditionally been distinct domains with almost no outpatient care delivered in hospitals. Ambulatory care is delivered by private office-based physicians (generalist and specialists) who are paid fee-for-service. Hospital inpatient care is provided by a mix of public and private providers (only a small proportion of total beds are in for-profit hospitals).

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