International Handbook of Medical Education

By Abdul W. Sajid; Christine H. McGuire et al. | Go to book overview

13
Germany

HEADRIK VAN DEN BUSSCHE

Since the unification of Germany in 1990, the educational system, research policy, and administration of health care in the former German Democratic Republic (GDR) have been undergoing dramatic transitions. Most probably, this process will consist of a progressive adaptation to the standards of the former West Germany ( Wissenschaftsrat 1991). As this process is still underway, the data and the analysis in this chapter refer to West Germany only.


OVERVIEW OF THE HEALTH CARE DELIVERY SYSTEM

Health services in the German Federal Republic (FRG) are delivered within a comprehensive and highly bureaucratic social security system that covers more than 90 percent of the population and provides for direct reimbursement to health care providers. The health services system employs approximately two million people (3.3 percent of the population), consumes more than 10 percent of the GNP, and is still growing, both in budget and work force, in spite of the expenditure containment laws of the last 15 years ( Sass and Massey 1988; Deneke 1988). The FRG is a leader among Western European countries with regard to the accessibility of services and the freedom of their use, acute hospital bed density (72 beds per 10,000 inhabitants), the number of hospital care days/population ( Sachverständigenrat 1987), the availability of sophisticated equipment ( Sachverständigenrat 1988) and the physician: population ratio. For example, the ratio of hospital care days to population is 100 percent higher than in the US and 200 percent higher than in the UK.

The German health care system is a loose aggregation of subsystems. The degree of coordination and cooperation among and within the subsystems (ambulatory care, hospital care, public health care, and rehabilitation) is low and competition is intense, including that among the sick funds (health insurance funds) for new members ( Light et al. 1986). The health care system is dominated by the providers, is disease and cure-oriented, and excels with regard to the

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International Handbook of Medical Education
Table of contents

Table of contents

  • Title Page iii
  • Contents v
  • Illustrations ix
  • Foreword xi
  • Preface xv
  • 1: An Overview of Medical Education in the Late Twentieth Century 1
  • References 12
  • 2: Evaluation and Change in Medical Education 13
  • References 18
  • 3: Australia 21
  • References 35
  • 4: Belgium 37
  • References 48
  • 5: Brazil 53
  • 6: Canada 65
  • References 75
  • 7: The Commonwealth (English-Speaking) Caribbean 81
  • References 96
  • 8: Chile 101
  • References 107
  • 9: The People's Republic of China 109
  • References 123
  • 10: Czech and Slovak Federative Republic 131
  • References 139
  • 11: Egypt 141
  • References 154
  • 12: France 155
  • References 169
  • 13: Germany 175
  • References 186
  • 14: Hungary 191
  • References 203
  • 15: India 207
  • References 219
  • 16: Israel 231
  • References 246
  • 17: Italy 249
  • References 254
  • 18: Japan 259
  • References 267
  • 19: Malaysia 275
  • References 288
  • 20: Mexico 291
  • References 300
  • 21: The Netherlands 305
  • References 317
  • 22: Nigeria 321
  • References 327
  • 23: Pakistan 331
  • References 342
  • 24: Poland 347
  • References 358
  • 25: Russia (Former USSR) 359
  • References 368
  • 26: South Africa 369
  • 27: Thailand 377
  • References 390
  • 28: United Kingdom 393
  • References 403
  • 29: United States of America 405
  • References 415
  • 30: Venezuela 417
  • References 428
  • Appendix A: General Country Demographics, 1989 437
  • Appendix B: Medical School Demographics, by Country 441
  • Appendix C: Admission Policies and Requirements, by Country 447
  • Appendix D: Policy Making Bodies with a Role in Medical Education 459
  • Appendix E: Professional Organizations with a Role in Medical Education, by Country 465
  • Appendix F: Governmental Agencies with a Role in Medical Education, by Country 469
  • Appendix G: Selected Bibliography 473
  • Appendix H: Acronyms and Abbreviations Used in This Handbook 485
  • Index 495
  • About the Contributors 511
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