The German healthcare system

German healthcare system overview

• There are two types of health insurance systems: public and private health insurance.
• Compulsory insurance: All German citizens are obliged to be insured with health insurance.
• The majority of the population is insured in the public health insurance. If citizens earn more than the compulsory insurance limit, are self-employed, students or civil servants they can take out private insurance.
• Health care is largely financed by contributions from citizens and their employers. Subsidies from tax revenues are also used to supplement it.
• In both private and statutory health insurance, the healthy insured thus finance the sick. However, there are differences in financing of the healthcare systems.

Structure of the health care system in Germany

The Federal Ministry of Health shapes health policy at the federal level. Its responsibilities include preparing legislation and drafting administrative regulations for self-governance in the health care system. Under the Federal Ministry are a number of agencies and institutions that deal with health issues assigned to them. Examples of such institutions include the Federal Institute for Drugs and Medical Devices (BfArM) and the Paul Ehrlich Institute (PEI). The former is responsible for the approval of medicinal products. The PEI has the task of approving vaccines.

For the statutory health insurance funds, the Federal Joint Committee (G-BA) is the highest decision-making body of the joint self-administration of health insurance funds, physicians, dentists, psychotherapists and hospitals. In the form of guidelines, it determines the benefits catalog of the statutory health insurance (SHI) or German gesetzliche Krankenversicherung (GKV) for about 70 million insured persons. It is also responsible for quality assurance measures in healthcare.

What social insurances do I need?

Some insurance in Germany is compulsory. These insurances do you need or pay automatically if you live and work in Germany.

1. The health insurance

   Health insurance has existed in Germany since 1883. There are two systems - the public health insurance and the private health insurance. The legal basis is based on the SGB V and the RVO. It is financed by contributions from insured persons (and their employers).

2. The nursing care insurance

   This has existed since 1995 and is based on the legal foundation of the SGB XI. Like health insurance, public long-term care insurance is financed by equal contributions from employees and employers (1.525% each). Childless persons pay an additional contribution. But there is also the possibility to have private long-term care insurance.

3. The accident insurance

   Accident insurance has been in existence since 1884 and is based on the legal foundation of SGB VII. Accident insurance is financed on a pay-as-you-go basis by the employer.

4. The pension insurance

   Pension insurance has existed in Germany since 1889. The legal basis is the SGB VI. The pension insurance is financed on a pay-as-you-go basis by the employee and employer in equal shares (9.95% each). Further income is provided by the federal subsidy.

5. Unemployment insurance

   This has been in existence since 1927 and is legally based on SGB III. Unemployment insurance is financed by contributions from employees and employers and, where applicable, subsidies. The contributions of the employees depend on their income.

What are the healthcare providers, associations and facilities?

In Germany, there is a framework for the organization of medical care. However, the organization and financing of the individual health services is administered by representatives of doctors, therapists, hospitals as well as health insurance companies. The supreme body here is the joint federal committee.

• Health insurance companies
• Dental associations
• German Hospital Association
• Any chambers such as the Medical Chamber, Dental Chamber, Psychotherapeutic Chamber and Pharmacy Chamber
• Public health service
• Pharmacists' associations
• Non-physician health care professions such as physiotherapists, midwives, speech therapists and nurses
• Patient organizations and self-help groups

Is healthcare free in Germany?

In Germany most people pay into the public German health care system. This system provides free medically necessary services for every German citizen, international tourist, and expats. This system of public health is funded by employee contributions, employer contributions, and government subsidies on a scale determined by income level. If your income is higher than 69,300 euros per year you have the option to choose private health insurance.

It is legally required that every person pays into some kind of health insurance system whether it is statutory health insurance or private health insurance.

Who can access healthcare in Germany?

The German healthcare system is accessible to everyone through public health insurance. It depends on the length of residence and what kind of insurance you need. Tourists and expats need private insurance if they live long-term or work in Germany. For people with a higher salary, there is the possibility to get into the private health insurance system.

How can I access healthcare in Germany?

In Germany everybody needs to have health insurance if they live or work here long-term. So you need to register with the German authorities in your town. There you get a German social insurance number which you need for the German healthcare system. The next step for access is to register for a health insurance fund.

Depending on your job status and income you can either choose between private and public health insurance or have to be compulsorily insured with a public health insurance.

Public vs. private German health insurance

Public and private health insurance are quite different when it comes to premiums or coverage. See the differences between private and public health insurance at a glance and read what type of health insurance you are eligible for.

Private health insurance in Germany

Private health insurance is an important pillar for the demographic change that is taking place in Germany. For every growing proportion of older people, there are few young people to shoulder the costs of society - not least in an item such as health insurance.

Privately insured persons, on the other hand, provide for themselves with their contributions and build up reserves for old age. Thus, in 2019, those insured in private health insurance had formed reserves in health and long-term care insurance amounting to 271.89 billion euros. A security that is indispensable for the German healthcare system. Contributions in the public health insurance system would otherwise rise immeasurably.

Who is eligible for private health insurance?

A growing number of people are opting for private health insurance. But not everyone is eligible for private health insurance. These people can get private health insurance:

• employees (income >€69.300)
• self-employed (regardless of their income)
• civil servants (regardless of their income)
• students (regardless of their income)

What benefits do I get with private health insurance?

By choosing a private health insurance policy, you can benefit from a wide range of health insurance coverage:

• Shorter waiting times
• Dental treatments
• Glasses and vidual aids
• Single or double room in the hospital
• Chief physician treatment in the hospital

There are numerous factors to consider before making your choice. To help you decide, we’ve put together a guide to different insurance types plus an explainer of the benefits of private health insurance.

What does private healthcare cost?

In private health insurance, the funded principle applies. The insurance companies calculate the premiums in advance for each individual insured person and build up reserves to keep premiums constant throughout the entire term. There is no premium increase due to illness during the insurance period.

The cost of private insurance depends on different factors. It considers your age, the coverage you want, and the conditions you already had before private insurance. So if you are young and healthy there is a higher chance to have fewer costs then older people with pre-conditions.

Can I combine public and private health insurance in Germany

If you are insured with public health insurance in Germany you can take out a private supplementary health insurance in order to get better health coverage.

There are health insurance plans for top-up-dental coverage for example or for top-up-clinic-insurance.

Outpatient & inpatient care in Germany

In Germany, medical care is divided into two areas: Outpatient and inpatient care.

Outpatient

Outpatient care includes all care services that are not provided by hospitals or clinics. Outpatient care is provided by all practicing and self-employed physicians, dentists and psychotherapists. Part of outpatient care are medicines, aids such as visual aids and hearing aids and the provision of remedies such as physiotherapy and occupational therapy.

Inpatient

Inpatient care is when a (longer) hospital stay is necessary. Patients with statutory health insurance must also pay a co-payment for room and board. A patient is treated as an inpatient in a hospital if the treatment objective cannot be achieved by other means. Admission to hospital for inpatient treatment is usually preceded by a referral from a general practitioner or an emergency referral. If full inpatient treatment is required, those with statutory health insurance have a direct legal entitlement to full inpatient treatment in an approved hospital.

What are pros and cons of the German healthcare system?

Germany has the highest spendings on health care in Europe and one of the best health care systems in the world. So there are many pros but also some cons.