Source: "German Studies" Issue 2, 2015

With comprehensive promotion of China's security health care system reform, medical insurance system has achieved full coverage and the level of protection system continues to increase. At the same time, there are some problems as well with China's medical insurance system, such as inadequate health care cost control (drugs' price is artificially high, etc.), the total amount paid in causing tension between doctors and patients, increase of resident medical insurance, conflicts among the mode of financing and so on. The reasons causing these problem are various, one of which is the lack of coordination mechanisms among different actors. Extreme conflicts events between health insurance agencies, medical service organizations, doctors and patients were frequently published on newspapers.

In contrast, Germany is the first country to establish social medical insurance system, but in the past 130 years the reform and development of it have achieved a high overall performance, and good governance in social justice, the overall health performance of which received praise from World Health Organization. Germany established a combined system of government and social governance in the medical insurance field, which played an important role in controlling the growth of medical costs, coordinating the interests of all parties to reach a consensus for change, and reducing conflicts. Since the 1990s, the public began to focus on the content of the German health insurance system and its reform dynamics. In recent years, in addition to focus on the German health insurance funding, payment mechanisms, the scholars preferred to focus on the management organization, mainly introduce the framework characteristics and operation mechanism of the medical insurance system. However, existing studies have mainly focused on the description of the microscopic perspective, lack of in-depth study of the German social health insurance system at the macro level.

This paper will summarize the German social health insurance as the combined operation system of government management and social management. The border of government management is only a necessary regulatory policy under a progressive implementation of the legal framework, and the premium payments, the quantity and quality of medical services supply, and specific medical matter control mainly rely on social management. The main body of social management is diseases fund associates and medical service associates. Different stakeholders, through an equal, open and transparent gaming and consultation, finally achieve government health policy objectives.