Healthcare in Germany
[11] According to the Euro Health Consumer Index, which placed it in seventh position in its 2015 survey, Germany has long had the most restriction-free and consumer-oriented healthcare system in Europe.
Bismarck stressed the importance of three key principles; solidarity, the government is responsible for ensuring access by those who need it, subsidiarity, policies are implemented with the smallest political and administrative influence, and corporatism, the government representative bodies in health care professions set out procedures they deem feasible.
[14] Mandatory health insurance originally applied only to low-income workers and certain government employees, but has gradually expanded to cover the great majority of the population.
Since 1976, the government has convened an annual commission, composed of representatives of business, labor, physicians, hospitals, and insurance and pharmaceutical industries.
The commission takes into account government policies and makes recommendations to regional associations with respect to overall expenditure targets.
[17] Historically, the level of provider reimbursement for specific services is determined through negotiations between regional physicians' associations and sickness funds.
[citation needed] In 1986, expenditure caps were implemented and were tied to the age of the local population as well as the overall wage increases.
Capitated care, such as that provided by U.S. health maintenance organizations, has been considered as a cost-containment mechanism, but since it would require consent of regional medical associations, it has not materialized.
of the population are covered by a 'Statutory Health Insurance' plan, which provides a standardized level of coverage through any one of approximately 1,100 public or private sickness funds.
[22][23] Since 2004, the German healthcare system has been regulated by the Federal Joint Committee (Gemeinsamer Bundesausschuss), a public health organization authorized to make binding regulations growing out of health reform bills passed by lawmakers, along with routine decisions regarding healthcare in Germany.
[25][26] The German law about the public health insurance (Fünftes Sozialgesetzbuch) sets the framework agreement for the committee.
[30] As of 2025, salaried workers and employees who earn less than €73,800 per annum[31] are automatically enrolled into one of currently around 105[32] public non-profit "sickness funds" (Krankenkassen).
[36] Provider payment is negotiated in complex corporatist social bargaining among specified self-governed bodies (e.g. physicians' associations) at the level of federal states (Länder).
[37] The sickness funds are mandated to provide a unique and broad benefit package and cannot refuse membership or otherwise discriminate on an actuarial basis.
[37] Social welfare beneficiaries are also enrolled in statutory health insurance, and municipalities pay contributions on their behalf.
However, the public health insurance coverage is determined by Federal Joint Committee (Gemeinsamer Bundesaussschuss).
88% of Germany's earning population is covered by statutory public health insurance funds,[45] regulated under by the Sozialgesetzbuch V (SGB V), which defines the general criteria of coverage, which are translated into benefit packages by the Federal Joint Committee.
Since then, the landscape of statutory health insurance organisations has undergone substantial changes, particularly through mergers and acquisitions.
Besides the primary governmental health insurance and the secondary private health insurance mentioned above, all governmental and private clinics generally work in an inpatient setting with a prepayment system, requiring a cost estimate that needs to be covered before the perspective therapy can be planned.
[75] Nevertheless, forces of the healthcare market in Germany are often regulated by a variety of amendments and health care reforms at the legislative level, especially by the Social Security Code (Sozialgesetzbuch- SGB) in the past 30 years.[timeframe?]
[76] In 2010, the total expenditure in health economics was about €287.3 billion in Germany, equivalent to 11.6 percent of the gross domestic product (GDP) and about €3,510 per capita.
[82] In a sample of 13 developed countries Germany was seventh in its population weighted usage of medication in 14 classes in 2009 and tenth in 2013.
[85] In 2002, the top diagnosis for male patients released from the hospital was heart disease, followed by alcohol-related disorders and hernias.
[86] In 2016, an epidemiological study highlighted significant differences among the 16 federal states of Germany in terms of prevalence and mortality for the major cardiovascular diseases (CVD).
A more relevant positive relation was found between the prevalence or mortality of major CVD and the number of residents per chest pain unit.
Bremen, Saarland and the former East German states had higher prevalence and mortality rates for major CVD and lower mean lifespan durations.
[90] In 2017 the BBC reported that compared with the United Kingdom the Caesarean rate, the use of MRI for diagnosis and the length of hospital stay are all higher in Germany.
(cited in Siciliani & Hurst, 2003, p. 8),[92] In the Commonwealth Fund 2010 Health Policy Survey in 11 countries, Germany reported some of the lowest waiting times.
[95][96] According to the National Association of Statutory Health Insurance Physicians in 2016,(KBV, Kassenärztliche Bundesvereinigung), the body representing contract physicians and contract psychotherapists at federal level, 56% of Social Health Insurance patients waited 1 week or less, while only 13% waited longer than 3 weeks for a doctor's appointment.
[92] As of 2014, Germany had introduced Diagnosis-related group activity-based payment for hospitals with a soft cap budget limit.
