Health system UK vs. Germany: Who performs better?

We pit the UK vs. Germany health system against each other: Beveridge or Bismarck, NHS or GKV - what are the biggest differences and which system performs better?

If you dive into ottonova's knowledge pages, you will get a good overview of the German health system. In order to better understand the context, it sometimes helps to think outside the box: What is it like to be insured in the UK, for example? And how does the UK vs. Germany health system compare?

Health System UK

How does the health system work in the UK?

The differences between the German health system and the British system could not be greater. While in Germany you have the choice between private and public health insurance, the UK has a one-size-fits-all system.

This means that there is no traditional health insurance in England - instead, the state takes care that every citizen has access to medical care and covers a large part of the costs for it. However, for some services, such as medicines, visual aids or dentures, the British have to pay extra themselves.

Nevertheless, there is one major common feature: Britons have the option of taking out private supplementary insurance or private comprehensive insurance to protect themselves from high costs.

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How does medical care work in the UK?

The first port of call for health problems is the local GP. However, the choice of GP is often restricted and influenced by where you live and whether you are on a special register. Only those with supplementary insurance are really free to choose.

Those who are referred to a specialist by their family doctor do not go to a practice as in Germany, but to the clinic. Since it can take a long time to get an appointment with a hospital doctor, private insurance also brings advantages for patients here.

Short excursus: Origin of the health care system UK vs. Germany

Otto von Bismarck was the father of social health insurance - and is the namesake of ottonova. He founded the German health insurance system, which is financed by social contributions from the insured and provides basic care for all citizens.

The British health system goes back to a report by the British parliamentarian William Beveridge in 1940. In it, based on the idea of a welfare state, he proposed giving every citizen access to medical care completely independent of their personal circumstances.

This system was to be financed by taxes. Following his recommendation, the National Health Service England was founded a few years later. In principle, the system is similar to the much-discussed citizens' insurance in Germany.

What is the National Health Service?

The National Health Service England (NHS) still embodies the British health system and is the employer of a large part of the medical staff. It reports to the government and is divided into four independent institutions for England, Scotland, Wales and Northern Ireland.

The NHS organises all medical care and its financing. The regional organisations decide, among other things, how best to support and ensure services in their region. Since its foundation in 1948, there have been repeated reforms and restructurings.

Are there public pensions or only private ones in the UK?

In addition to the NHS, there is also National Insurance (NI) in England's social system, which, among other things, provides for old age. In the UK, every citizen has a national insurance number through which social security contributions are registered in order to distribute benefits accordingly in case of unemployment or old age. The employer also participates in this state provision for old age.

Costs in the health system in Great Britain: Financing through taxes

The German health system is financed according to the solidarity principle. Employers and employees pay into a large pot that finances the GKV. The basis for the contributions is the level of income. Medical progress is mainly financed by PKV, where contributions are based on the personal risk of the insured.

England's social system is organized slightly differently. As mentioned above, the health system is not financed by social security contributions but by taxes.

Thus, the British do not pay a direct contribution to a health insurance scheme. Instead, the state finances the health system, which is therefore closely linked to the state budget and the government's financial policy. For this reason, there have been repeated losses in the quality of treatment in recent years.

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Health care system UK vs. Germany - who performs better?

The British health system offers citizens quasi-contribution-free medical care, regardless of their personal circumstances. UK spending on health is state-regulated and lower than in Germany, for example.

However, the austerity course regularly takes its revenge, for example when the flu breaks out. The Corona pandemic in particular clearly showed how different the health systems in England and Germany are. While the German system received much credit from other countries, experts warned of a possible collapse of the British health system right at the beginning of the pandemic.

Limitations of the UK health system

In principle, state-funded healthcare sounds advantageous and indeed the UK is proud of its own healthcare system. However, the almost free health care system repeatedly reaches its limits:

Other aspects of the British health system compared to Germany are summarized in the following table:

Main Idea

  • Welfare state based on Otto von Bismarck


  • split into private and public health insurances


  • financed by social security contributions


  • Reimbursement of insured services directly by the GKV
  • Private patients first pay themselves and then get the money back from the insurance company

Special features

  • GKV contributions rise due to demographic change
  • Limited benefits in GKV and sometimes high co-payments for dental treatment

Main Idea

  • Welfare state based on William Beveridge


  • National health system organized by the NHS


  • financed by tax money


  • Billing via the NHS
  • Patients pay themselves for what the NHS does not reimburse Private supplementation of insurance cover is possible

Special features

  • GP model – except in emergencies
  • Outpatient specialist care only in clinics
  • Low doctor density often leads to long waiting times
  • No catalogue of services and thus sometimes high co-payments for patients
ottonova Magazin Autor
HIER SCHREIBT Espen Markus Mjøs

Espen Markus - originally from Norway - is sales agent in ottonova's English sales team. He's in contact with potential customers every day and answers Expats' questions about German health insurance.

ottonova Magazin Autor
HIER SCHREIBT Sabrina Quente

Sabrina is a freelance writer for insurance and digitalization topics. She was an editor at trade magazines and got to know the many facets of the insurance world as a content editor at ottonova.

ottonova sales experts
HIER SCHREIBT ottonova sales experts

Our ottonova team of experts has over 40 years of experience in private health insurance and answers questions about it every day. What are old-age provisions and for whom does private health insurance make sense? What is the actuarial interest rate and which tariff is right for you? They know!

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