Population Insurance Coverage For A Core Set Of Healthcare Services* (%) (2017):
Public Coverage: 89.4%; Primary Private Health Coverage: 10.6%; Total: 100%

*“Population coverage for health care is defined here as the share of the population eligible for a core set of health care services – whether through public programmes or primary private health insurance. The set of services is country-specific but usually includes consultations with doctors, tests and examinations, and hospital care. Public coverage includes both national health systems and social health insurance. On national health systems, most of the financing comes from general taxation, whereas in social health insurance systems, financing typically comes from a combination of payroll contributions and taxation. Financing is linked to ability-to-pay. Primary private health insurance refers to insurance coverage for a core set of services, and can be voluntary or mandatory by law (for some or all of the population.”

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.

“Since 2009, all residents in Germany are required to have statutory health and long-term care insurance or at least equivalent coverage through a PHI [Private Health Insurance] plan. Patients who are eligible for coverage through the SHI [Statutory Health Insurance] system have virtually free choice of sickness funds and, in general, may switch sickness funds after an 18-month waiting period. Individuals covered by SHI are free to take out supplementary health insurance offered by private insurance companies. Individuals with PHI may also choose freely among private health insurers. Switching from one private insurance company to another has been made easier since the possibility was introduced in 2007 to have active life reserves transferred from an old to a new insurer.

“Sickness funds are obliged to contract with all eligible applicants regardless of income or health status. Since January 2009, private health insurers have been obliged to offer a policy (the so-called Basistarif) covering services equivalent to those offered by SHI and at a price not exceeding the maximum contribution within the SHI system; applicants may not be rejected based on factors such as income or health status. Risk selection, however, is still permissible for the other health insurance plans offered by these companies.”

Source: Busse R, Blümel M. Germany: health system review. Health Systems in Transition, 2014, 16(2):1–296.

“Patients in Germany generally have free choice of physicians. Individuals with private insurance or paying out of pocket have access to all licensed health providers except when this is precluded by contractual limitations. Individuals covered by SHI may choose freely among ambulatory care physicians who have been accredited by the sickness funds to treat SHI-covered patients (i.e. some 98% of all ambulatory care physicians in Germany). Patients may also choose freely among hospitals that have been contracted by the sickness funds; the beds in these hospitals represent 99% of all hospital beds in the country. Limitations that apply to patients’ free choice of physicians are the lower physician-to-population ratio and greater travel times in rural areas, especially in the eastern part of the country (Wörz, Babitsch & Busse, 2006; Riesberg & Wörz, 2008).”

Source: Busse R, Blümel M. Germany: health system review. Health Systems in Transition, 2014, 16(2):1–296.

“Health insurance in Germany is compulsory and consequently offers almost universal coverage. The German health system is split into public social health insurance (SHI) and private health insurance (PHI), with a number of criteria determining who is insured in which. Employees are usually insured in the SHI, but people whose income is above a fixed threshold or who belong to a certain professional group, e.g. self-employed or civil servants, can opt to enrol in PHI for full insurance. The multi-payer SHI system currently consists of 109 sickness funds covering 87 % of the population, and about 11 % of the population is covered under one of the 41 private health insurance companies. Other specific groups (e.g. soldiers, police) are covered under special schemes. Although coverage is universal for all legal residents, there are still gaps due to financial or administrative barriers (Section 5.2).”

Source: OECD/European Observatory on Health Systems and Policies (2019), Germany: Country Health Profile 2019, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.

“A patient charter introduced in 2002 was developed by patient representatives, physicians, hospitals, sickness funds, private insurance companies, charity organizations, self-help groups and the Citizens Advice Bureaux in addition to the state ministries dealing with the areas of health and justice. The charter aimed to make existing legislation pertaining to health and health care more transparent for patients, describing patient rights with regard to counselling, medical care and informed consent, and focusing on the expectations, rights and duties of patients and physicians. In summary, patients in Germany have the right to:

• choose their physician and hospital freely;
• seek a second opinion;
• receive qualified and judicious medical treatment according to recognized standards of medical practice;
• determine the type of treatment they should receive and the extent of this treatment;
• use sign language or other communication aids if necessary to interact with their physician and have the cost covered by their sickness fund;
• insist that all medical procedures be performed only with their legal consent;
• obtain individual advice from their sickness funds about insurance benefits;
• be treated with pharmaceuticals or medical products that satisfy the legal quality and safety requirements;
• receive timely, face-to-face information about a proposed treatment;
• receive a written record of their most important diagnoses and treatments;
• view their own medical records and have copies made of them at their own expense;
• have their patient data treated with confidentiality; and
• receive compensation in the event of medical error, lack of informed consent, or injury caused by pharmaceuticals or medical devices.

“In February 2013, the parliament passed the Patients’ Rights Act (Patientenrechtegesetz). This general law on patient rights bundles several existing jurisdictions and gives detailed regulations (e.g. for complaint procedures; see sections 2.9.4 and 6.1.7).”

Source: Busse R, Blümel M. Germany: health system review. Health Systems in Transition, 2014, 16(2):1–296.

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated May 20, 2021 by Doug McVay, Editor.