Kamal Osman
The Federal Republic of Germany is composed of sixteen states, the so-called „Bundesländer“ or “Länder”. Germany has one of the highest population density within the European Union. In December 2005 the number of doctors was 373 per 100,000 inhabitants. Healthcare is funded by a statutory contribution system that ensures free healthcare for all via sickness funds. Insurance payments are based on a percentage of income, divided between employee and employer. Healthcare insurance in Germany is divided between statutory and private schemes. The statutory health insurance, the so-called “Gesetzliche Krankenversicherung” (GKV), occupies a central position in the Healthcare system in the Federal Republic of Germany. About 90 % of the population are covered by the statutory health insurance which is compulsory for all who earn less than 3862,50 € (in 2004) before tax. Private healthcare schemes can either provide to complete health service for those who opt out for the GKV or top-up cover for those who remain within it.
In Germany, the provision of healthcare can be broadly separated into ambulatory and in patient sectors. Outpatient services supplied to the public are largely the responsibility of independent doctors practising on a freelance basis under contract to the statutory health insurance. Doctors caring for patients who have sickfunds must be registered by law by the regional association of Statutory Health Insurance Physicians (Kassenärztliche Vereinigung).
Hospitals in Germany are grouped into three main types:
Medical studies take a minimum of six years. In the last year, the so-called “Praktisches Jahr”, the students work in a university hospital or a teaching hospital and have four months attachments both in medical and surgical specialities and four months in a speciality of their choice. This is followed by an examination “Zweiter Abschnitt der ärztlichen Prüfung”, formerly by an examination “Dritter Abschnitt”. After graduating the student is a doctor/physician. The doctor gets full license (Approbation) which entitles the physician to practise the medical profession. Formerly the physician got a temporary license to practise as a doctor/physician . After another 18 months of internship (Arzt im Praktikum) the physician received the definite licence to Practise (Approbation). Postgraduate training time may take four to six years depending on the speciality.
Continuing Medical Education is mandatory for all physicians practicing in Germany. The German Medical Association has issued a Regulation Framework for Continuing Medical Education which serves as a model regulatory procedure for all State Medical Chambers in Germany.