In Germany, the influence of providers of medical services has long been subordinated to that of government and public policy making bodies. Public involvement in the health field is the result of a social commitment to a right to health care made a century ago and most widely manifests itself today in national health insurance for about 87 per cent of the population. Other restraints on the providers are the influence of trade unions, business management, political parties, and officials of the federal and state governments. Due to a built-in concern for the consumer, and its more integrated and coordinated organizational structure, the German health system attempts to benefit the recipient at least as well as the provider of health services.
Until recently, the health scene in the United States has been characterized by a lack of positive government action. While this is consistent with the United States' traditional concern for pluralism and individualism, the result has been to vest a predominant policy making role to the private enterprise providers of medical services. The medical community in the U.S. has had a long and successful political career through its lobbying activities. Entry to the medical profession, physical facilities, and standards have all been controlled by the physicians themselves. Current trends and concerns for the consumer, however, have both identified and challenged deficiencies in performance under the influence of self-regulating providers.
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