gms | German Medical Science

Background: The population perspective has become highly relevant for health systems aiming at improving population health and for the assessment of the health system performance. Since the overall population is very diverse, the individual assessment may be influenced by several factors and may vary across different population groups. About 11% of the German population has substitutive private health insurance (PHI). This population group mainly consists of self-employed persons, civil servants or persons with an income above a certain threshold (in 2020: 62,550 €/year) who choose to opt out from statutory health insurance. It can be assumed that these persons represent a unique population group in Germany.

Research objectives: The assessment of the German health system performance from the perspective of persons with PHI was subject to the research project “Integrating the Population Perspective in Health System Performance Assessment” (IPHA) [1].

Methods: In 2018, a paper/online survey was conducted among 20,000 persons with PHI of one health insurance company in Germany. The items for this survey were based on the intermediate (access, coverage, quality and safety) and final goals (improved health, responsiveness, improved efficiency, and social and financial risk protection) of the WHO Health Systems Framework. Descriptive statistics were used to analyze the data.

Results: The survey was completed by 3,601 participants (18.0%). Participants (58.6 years ± 14.6; 64.6% male) assessed the German health system very differently, exemplarily shown hereafter for the intermediate goal “access” and the final goal “responsiveness”: Access to off-hour care was perceived as difficult by 54.1% of the respondents. Another 6.7% of the respondents reported unmet needs within the last 12 months due to waiting times, and 51,5% of these persons with unmet needs were (very) satisfied with the overall waiting time for physicians’ appointments. 73,6% of persons with unmet needs who perceived discrimination in their care reported waiting times as the area of discrimination (vs. 53,4% of all participants who perceived discrimination).

Discussion: Privately insured persons in Germany perceived the performance of the German health system very differently, also partially inconsistent. For example, despite reporting unmet needs due to waiting time, more than half of these persons were still (very) satisfied with the waiting times for a physician’s appointment.

Practical implications: The assessment of the health system performance from the perspective of persons with PHI in Germany may help to identify ways for the improvement of health care, especially for persons with PHI. So far, persons with PHI are underrepresented in health services research in Germany, and therefore new insights can be gained from this research.