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KMID : 0613620220420040228
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Health Social Welfare Review
2022 Volume.42 No. 4 p.228 ~ p.247
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Out-of-Pocket Maximum Policy in Germany’s Health Insurance System: A Focus on the Implications for Korean Health Insurance
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Woo Kyung-Sook
Shin Young-Jeon
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Abstract
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Purpose: The aim of this study was to provide policy implications for improving the effectiveness of the policy regarding out-of-pocket maximum in Korea by examining the operational method and characteristics of this policy that is stably implemented in Germany. Coverage: It applies to the benefits of insured persons registered in statutory health insurance. Two-Level Maximum Policy: It sets a maximum cap per item at the time of initial use of the benefit, and establishes the annual cap per household. Management and Operation: The sickness funds operates based on the co-payment ceiling regulations. Ceiling Calculation: The general cap is set at 2% of the annual household income, lowered to 1% for households with chronically ill members. Evaluation: Germany has improved practicality while securing equity between classes by considering household members, economic levels, diseases, and disabilities in co-payment ceiling. Conclusion: Out-of-Pocket Maximum operates as a medical safety net by precisely designing co-payment ceilings based on income. German co-payment system may be utilized for improving co-payment policies in Korea.
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KEYWORD
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Germany, Statutory Health Insurance (GKV), Co-Payment, Out-of-Pocket Maximum Policy, Health Care Coverage
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