Skip to main content

The Bismarck Model

Otto von Bismarck
In 1883, the reactionary German chancellor Otto von Bismarck, a Prussian autocrat through and through, proposed the health care model that came to be adopted by many European nations and that echoes decisively today in the American health care apparatus. Though no social reformer, Bismarck viewed universal health insurance as an effective tactic in his grand design for German unification, which trumped his conservative tendencies. What has come to be known as the Bismarck Model survived the German militarism of World War I, the unstable democracy of the Weimar Republic, Naziism, World War II and its aftermath, and eventual reunification. Its durability cannot be doubted.

Today, the Bismarck Model serves as the predominant means of guaranteeing universal coverage in Europe, used in Germany, France, Switzerland, Belgium, Netherlands, and others. (Japan is also a Bismarck Model country.) The implementation varies, but all mandate insurance in one form or another. In Germany, for example, employers and employees jointly fund insurance via withholding; in Switzerland, individuals purchase their own policies. Even so, Bismarck Model countries share common traits:

  • Short waits, quality care, relatively low costs, and simplified administration
  • Tight regulation of insurance which is often (but not always) sold on a nonprofit basis
  • Claims paid without challenge
  • No exclusion for pre-existing conditions
  • Prices for most procedures fixed by the state
  • Private hospitals and physician practices
  • Generally high positions in the World Health Organization's overall rankings
There are, of course, tradeoffs. By eschewing a socialized system for which culturally most of them are ill-prepared, the Bismarck nations accept greater costs and less efficiency. (In health care, efficiency refers to performance measured against outcomes and costs.) While physicians receive a free education, have virtually no administrative overhead, and are rarely sued, they also earn less than their American counterparts. Moreover, despite state price fixing, cost issues are often addressed by raising premiums instead of controlling costs.


With the exception of veterans eligible for the VA system and active duty military personnel, most Americans under the age of 65 are either self-insured or have health insurance either as a benefit of employment. However, as indicated in the table above, the American approach to health insurance comes at a much greater cost than to countries operating under a pure version of the Bismarck Model. Lessons we can draw from these countries include:

  • The importance of a universal mandate for insurance under the auspices of single program
  • Consumer protections such as no exclusion for pre-existing conditions are feasible only with mandates
  • Immediate payment of claims without challenge lowers administrative burden and the financial impact on patients
  • Insurance regulation, nonprofit insurance, and a fixed price for procedures help control costs
  • Privatized care can exist successfully in a regulated environment
Later, HealthMatters will look in detail at the approaches of various Bismarck Model countries.

    Popular posts from this blog

    Puas Rental dan Sewa Mobil Di Area Cirebon

    Puas Rental Mobil Cirebon . Puas Rent car ialah perusahaan transportasi penyedia layanan rental mobil di Cirebon. Puas Rent Car ialah bagian dari perusahaan Puaspark – taman rekreasi keluarga sangat terjangkau di Cirebon Timur. Kami pun melayani lokasi Bekasi sampai Seluruh Cirebon. Armada kami ialah mobil-mobil dalam situasi terawat dan pun mobil-mobil keluaran baru. Dengan opsi mobil yang kami sediakan paling variatif dan harga yang paling kompetitif di Cirebon.
    Contact Puas Rental Mobil



    Bagi Kami Kepuasan Konsumen nomer Satu..
    Untuk Pemesanan klik Rental Mobil Avanza Di Area Cirebon
    Karena Disitu Adalah Website Resmi Dari Puas Rental Mobil Cirebon

    Puas Rent Car Cirebon menawarkan guna Anda seperti: Avanza. Kami melayani penyewaan mobil guna harian maupun bulanan. Kami meluangkan supir. kita juga dapat menyewa mobil-mobil kami tanpa supir.

    Menjadi perusahaan transportasi penyedia jasa penyewaan mobil yang handal. Menjadi parner transportasi terbaik Anda. Terdepan melayani sewa / ren…

    The Food Allergy Herbal Formula-2 (FAHF-2) Laundry List

    So in all the time I've been writing about our experience with FAHF-2, I have never done a comprehensive post with all the links/info I've found over the years. Consider the situation rectified! I'll add to this as I find new sources. If you have good ones, please feel free to add them to the comments as well.

    My FAHF-2 Posts
    FAHF-2 Trials In Chicago!

    We're In

    BTDT, Got the FAHF-2 Food Allergy Clinical Trial T-Shirt

    Brief FAHF-2 Update

    Halfway There...But the Second Half Is All Uphill

    FAHF-2: The Holy Grail?

    Waiting in the Wings for the Show to Begin

    FAHF-2 Clinical Trial Summary

    Other People's FAHF-2 Experiences (from around the web)Chinese pharmacy vs. through Dr. Li

    For severe eczema/MRSA

    New York Times article

    For asthma (Vitality magazine)

    An asthma patient's personal experience

    Description of Dr. Li's treatment plan

    What Is FAHF-2?Patent application (contains all ingredients)

    Phase 1 Clinical Trial Report (has very specific info about formula ingredients)

    Yellow Empero…

    inaugural post

    The Starker Arts Garden for Education finally has its very own blog. There's so much happening out at the garden that we just couldn't keep all the news from you any longer!

    Stay tuned to this blog for updates on SAGE, upcoming event info, sustainable gardening tips, and other good grub fresh from the garden!  Feel free to subscribe to our blog by entering your e-mail address into the "Follow by E-mail" bar to the right.