Germany has health insurances, both private and public but there is not one unified system really.
I can go to a doctor and pay the bill on my own without getting in touch with any government organization.
Gematik also is a private company according to their website. So nothing that is associated with the government.
When you go to the doctor you are presumably insured. So your doctor needs to communicate with your insurance. Insurers might need to communicate with government agencies and regulatory bodies, and so on. If you've seen Covid data in Germany, that data comes from every corner in Germany, and all those institutions need to be able to talk toe each other.
Why in the world do I get a piece of paper from my doctor that I'm supposed to mail to my insurance provider (or scan and upload if you're lucky) when I'm being diagnosed with something?
Doctor's offices are the least digitized businesses around.
There's first signs of this getting better, but I can't wait for things to change...
>Doctor's offices are the least digitized businesses around.
Oh? Here in the US I can't remember the last time I had to take a prescription on paper from a doctor. Whether CVS, Walgreens, or Amazon PillPack, when my doctor prescribes medication, the pharmacy receives it very quickly, sometimes within minutes. Same with lab work; whether my health system's own labs or a third party like LabCorp or Quest, it's all electronic.
(The process is not all electronic. When a prescription expires, if I request that the pharmacy renews it (as opposed to requesting a renewal from the prescribing doctor), I believe the pharmacy calls the doctor. But either way, I don't otherwise get involved other than, in both cases, requesting it via a website.)
Gematik is completely owned by public institutions (including medical self-governing institutions) except for a very minor stake of the PKV-Verband.
>Germany has health insurances, both private and public but there is not one unified system really.
Correct. Far too often, people in the US and UK think that
1) every developed country other than the US has "national health care" or "universal health care"
2) every such country does it like the UK, a monolithic system in which the government owns both the biller (single payer) and provider (hospitals)
Regarding 2), the UK system is unusual in being so monolithic. Canada has single payer but neither the national nor local government owns and operate all hospitals. Australia's system puts significant emphasis on private insurance as the alternative or preferred option to public insurance. Germany, Switzerland, Austria, and others have a variety of private and public insurance companies and hospitals, typically differentiated by income level or profession. France's system is somewhere in the middle.
Regarding 1), since Obamacare there is essentially no difference between the US's system and Germany's or Switzerland's. The US has always had a mix of public (Medicare/Medicaid, military, VA, IHS), nonprofit (Kaiser), and for-profit (Anthem) insurance providers, as well as public (military, VA, and various state- and local government-owned), nonprofit (Kaiser again, university hospitals), and for-profit (various hospital chains) deliverers. Obamacare merely mandated that the 15%[1] of Americans pre-Obamacare that did not have health insurance get it or pay a penalty. The figure is 8% now.
And before you say "Well, that's not 100%", while the penalty for Obamacare noncompliance is not high enough, 92% of Americans having health insurance is not very far from the 95-97% elsewhere. There are always people who fall between the cracks, whether a German who neglects to sign up for a new sickness fund after changing jobs, or a Canadian who neglects to sign up for a new provincial health care card after moving. The only way to get actual 100% coverage is to use the UK NHS model of having no membership card at all.
[1] Yes, 85% of Americans before Obamacare had health insurance. How many of you non-Americans (heck, many Americans) thought that "0% of Americans have healthcare" before or after Obamacare? It's OK; you're not alone in believing everything you read on Reddit.
Just for the record: There is nothing you have to do when switching jobs in Germany - you just keep your previous health fund. There is a very small amount of people without health insurance but once you are in the system (which I think is fair to call "national healthcare system") you will find it very hard to leave even if you try.
The "public" is private anyway, as the Krankenkassen are all private companies (although strictly regulated by BMG).
But yes, there's concept of public (statutory) and private (voluntary) insurance plans.
On top of that, as you said, most (all?) Arztpraxen are also private entities. Same goes for hospitals (I guess excluding places like universities and Bundeswehr).
Many hospitals are part of a municipality or a university (again, established by public law), many others are organized as private companies (either publicly or privately owned). Non-hospital doctors are almost completely private entities.
This is not so clear-cut as in other countries.
Translated from Wiki:
> As a public corporation with self-administration, a health insurance fund regulates its budget on its own responsibility. In doing so, it must fulfil legislative performance requirements (compulsory benefits) and may in some cases go beyond this (statutory benefits). According to § 260 para. 2 SGB V, its operating funds should not exceed one monthly expenditure.
Health care might be organized differently than in most other countries but that does not imply that those institution are private.
Is the City of Munich also a private company? It has self-administration, is responsible for its own budget which can't be negative, has to operate within legislative bounds including giving compulsory benefits to its residents (which are exactly the criteria you quote). Of course not, that's a city. What about the Technical University of Munich? They even have "members" instead of residents in addition to the things above. It's all the exact same kind of legal entity. Saying one is public and the other one private doesn't make any sense. What's the difference between those in your eyes?