The German Social Insurance Program’s Role in the Rehabilitation of Mentally Ill Patients

Abstract

The Bismarck legislation of 1881 recognized that health is a public asset. Subsequent legislation has required that everyone either have health insurance or demonstrated ability to pay medical bills by having sufficiently high income.¹ It is understood that everyone must pay his/her medical bill, which 90% of the population does through one form or another of health insurance. These are:

• 1) legal health insurance: financed by employee, employer, pays for diagnosis and treatment of diseases

• 2) pension insurance: pays for rehabilitation of disabled people likely to return to the workforce

• 3) unemployment insurance: supports measures to reintegrate workers into the labor force, such as wages if a person unemployed for a year or more is hired, new skills training, etc.

• 4) nursing insurance: relatively new (1995), this fund is financed compulsory insurance to pay for nursing care at home or in nursing homes if that level of care is needed. For chronic disease. Chronic mental disease is excluded. The counterpart in the U.S.A. for disabled people or those over 65 is Medicare, which also excludes equal coverage for mental illness

• 5) legal accident insurance: every employer must enroll its employees in this system, which covers acute treatment, rehabilitation, reintegration into the labor market, nursing, etc. Despite its name, it does not resemble Workmen’s Compensation in the U.S.A., but rather the usual indemnity or fee-for-service coverage for workers that was the pre-managed care form of health insurance in the U.S.A.

• 6) public assistance: financed by local tax income of cities and counties, this system provides backup if any other fund does not provide coverage, or if a person has failed to join the mandatory insurance system