Skip to content
World Health Systems Facts

Germany: Health System Coverage

Germany: Health System Coverage

German Health System Overview
Health System Rankings
Outcomes
Health System Coverage
Costs for Consumers
Health System Expenditures
Germany’s COVID-19 Strategy

Health System Financing
Medical Personnel
Health System Physical Resources and Utilization
Long-Term Care
Medical Training
Health Information and Communications Technologies
Pharmaceuticals

Political System
Economic System
Population Demographics
People With Disabilities
Aging
Social Determinants & Health Equity
Health System History
Health System Challenges


Population Insurance Coverage For A Core Set Of Healthcare Services* (%) (2019):
Public Coverage: 89.5%; Primary Private Health Coverage: 10.5%; 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 (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.


“Health insurance is compulsory in Germany, provided either under the SHI [Statutory Health Insurance] scheme or through substitutive PHI [Private Health Insurance]. 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. the self-employed or civil servants, must or can opt to enroll in PHI for substitutive full coverage. Around 87% of the population is covered through SHI, while approximately 11% has substitutive PHI coverage. The other 2% (e.g. soldiers) are covered under special programmes. Around 61 000 people are uninsured.

“SHI covers a broad benefits basket, well beyond essential services, and benefits are the same for all those insured. Individuals covered by substitutive PHI usually enjoy benefits equal to or better than those covered by SHI. Benefits covered by SHI are legally defined in generic terms at the federal level, while details and decisions on including new technologies, pharmaceuticals or medical devices in the benefits basket are at the discretion of the Federal Joint Committee. These decisions are guided by structured Health Technology Assessments and are binding for all sickness funds, providers and patients.”

Source: Blümel M, Spranger A, Achstetter K, Maresso A, Busse R. Germany: Health system review. Health Systems in Transition, 2020; 22(6): pp.i–273.


“Patients in Germany generally have free choice of physicians (GPs and specialists). Individuals with private substitutive insurance (e.g. employees above an opt-out income threshold, the self-employed or civil servants) or who pay out of pocket have access to all licensed health care 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 Regional Associations of SHI Physicians 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. Since 2009 all residents in Germany are required to have statutory health and long-term care insurance or substitutive coverage through a PHI plan. Patients who are eligible for coverage through the SHI 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 substitutive PHI may also choose freely among private health insurers. For those insured under substitutive PHI 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. Long-term care funds/insurers cannot be chosen freely as these are administratively connected to the sickness fund/health insurers (see Section 5.8 Long-term care).

“Recipients of long-term care benefits have free choice of their care provider based on the principle of self-determination. They can choose between in-kind benefits, cash benefits or a combination of the two. In general, patients can choose between different treatment options (if available) out of the given alternatives from a provider. Based on patient rights, other possibilities for patient choices relate to participating in (shared) treatment decisions and requesting second opinions from different providers (see Table 2.6).”

Source: Blümel M, Spranger A, Achstetter K, Maresso A, Busse R. Germany: Health system review. Health Systems in Transition, 2020; 22(6): pp.i–273.


“Germany has the oldest social health insurance (SHI) system in the world. Health insurance is compulsory, but people with an income above a fixed threshold or belonging to a particular professional group (e.g. self-employed people or civil servants) can opt out of SHI coverage and enrol in (substitutive) private health insurance (PHI). About 11% of the population are covered by PHI; 89% by SHI. Although coverage is universal for all legal residents and only 0.1% of the population do not have health insurance, there are still gaps due to financial or administrative barriers (see Section 5.2). The multi-payer SHI system currently consists of 103 sickness funds and 41 PHI companies, and the three biggest sickness funds cover more than one third of the German population.”

Source: OECD/European Observatory on Health Systems and Policies (2021), Germany: Country Health Profile 2021, State of Health in the EU, OECD Publishing, Paris/European Observatory on Health Systems and Policies, Brussels.


“Since 2013 the Patient Rights Act (Gesetz zur Verbesserung der Rechte von Patientinnen und Patienten) has anchored patient rights in the German Civil Code §630a–h for all medical treatments by physicians and other health care professionals. Patients in Germany have the right to choose their physician and hospital freely; to seek a second opinion; to receive medical treatment according to recognized standards; to determine the treatment and its extent; to have the cost covered by their sickness funds for necessary communication aids to interact with physicians; to have medical procedures performed only with their legal consent; to receive a (patient) receipt (Patientenquittung) from their sickness fund, physicians, dentists or hospitals with a listing of costs and services obtained; to view their own medical records and have copies made at their own expense; to have their patient data treated with confidentiality; and to receive compensation in the event of medical error, lack of informed consent, or injury caused by pharmaceuticals or medical devices (see Table 2.7).

“Since 2006 there is also a Charter of Rights for People in Need of Longterm Care and Assistance containing eight articles on the following areas: self-determination and support for self-help; physical and mental integrity, freedom and security; privacy; care, support and treatment; information, counselling and informed consent; communication, esteem and participation in society; religion, culture and beliefs; and palliative support, dying and death (Bundesministerium für Familie, Senioren, Frauen und Jugend (BMFSFJ), 2019).”

Source: Blümel M, Spranger A, Achstetter K, Maresso A, Busse R. Germany: Health system review. Health Systems in Transition, 2020; 22(6): pp.i–273.


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 sixteen other nations.


Page last updated August 7, 2022 by Doug McVay, Editor.

  • Home
  • About Health Systems Facts
    • Contact Us
    • Join Our Email List
  • Breaking News & Opinion
  • Upcoming Events
  • Seventeen National Health Systems
    • Austria
    • Canada
    • Costa Rica
    • Czech Republic
    • Denmark
    • France
    • Germany
    • Hungary
    • Italy
    • Japan
    • Netherlands
    • South Korea
    • Spain
    • Sweden
    • Switzerland
    • United Kingdom
    • United States
  • Comparing National Health Systems
    • Healthcare Access and Quality Index
    • Sustainable Development Goals Health Index
    • Mirror Mirror 2021
    • World Health Report 2000
    • International Health Systems In Perspective
    • Lessons for US Health Reform
  • Aging
  • Health System Outcomes
  • Healthcare Spending
  • Healthcare Workers
    • Health System Personnel
    • Health Workforce Training
  • Information and Communications Technologies
  • Long-Term Services and Supports
  • People With Disabilities
  • Pharmaceutical Pricing and Regulation
  • Social Determinants Of Health
  • Wasteful Spending
  • Various US Health System Proposals
    • Affordable Care Act
    • All Payer
    • Public Option
    • Single Payer / “Medicare For All”
    • Universal Health Coverage
  • Recommended Resources
  • Privacy Policy
    • Cookie Policy
  • Facebook
  • LinkedIn
  • Twitter

© 2019-2022 Real Reporting Foundation | Theme by WordPress Theme Detector

We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. By clicking “Accept”, you consent to the use of ALL the cookies.
.
Cookie SettingsAccept
Manage consent

Privacy Overview

This website uses cookies to improve your experience while you navigate through the website. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. We also use third-party cookies that help us analyze and understand how you use this website. These cookies will be stored in your browser only with your consent. You also have the option to opt-out of these cookies. But opting out of some of these cookies may affect your browsing experience.
Necessary
Always Enabled
Necessary cookies are absolutely essential for the website to function properly. These cookies ensure basic functionalities and security features of the website, anonymously.
CookieDurationDescription
_GRECAPTCHA5 months 27 daysThis cookie is set by Google. In addition to certain standard Google cookies, reCAPTCHA sets a necessary cookie (_GRECAPTCHA) when executed for the purpose of providing its risk analysis.
cookielawinfo-checkbox-advertisement1 yearThe cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Advertisement".
cookielawinfo-checkbox-analytics11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Analytics".
cookielawinfo-checkbox-functional11 monthsThe cookie is set by GDPR cookie consent to record the user consent for the cookies in the category "Functional".
cookielawinfo-checkbox-necessary11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookies is used to store the user consent for the cookies in the category "Necessary".
cookielawinfo-checkbox-others11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Other.
cookielawinfo-checkbox-performance11 monthsThis cookie is set by GDPR Cookie Consent plugin. The cookie is used to store the user consent for the cookies in the category "Performance".
viewed_cookie_policy11 monthsThe cookie is set by the GDPR Cookie Consent plugin and is used to store whether or not user has consented to the use of cookies. It does not store any personal data.
Functional
Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features.
Performance
Performance cookies are used to understand and analyze the key performance indexes of the website which helps in delivering a better user experience for the visitors.
Analytics
Analytical cookies are used to understand how visitors interact with the website. These cookies help provide information on metrics the number of visitors, bounce rate, traffic source, etc.
CookieDurationDescription
_ga2 yearsThis cookie is installed by Google Analytics. The cookie is used to calculate visitor, session, campaign data and keep track of site usage for the site's analytics report. The cookies store information anonymously and assign a randomly generated number to identify unique visitors.
_gat_UA-71314304-21 minuteThis is a pattern type cookie set by Google Analytics, where the pattern element on the name contains the unique identity number of the account or website it relates to. It appears to be a variation of the _gat cookie which is used to limit the amount of data recorded by Google on high traffic volume websites.
_gcl_au3 monthsThis cookie is used by Google Analytics to understand user interaction with the website.
_gid1 dayThis cookie is installed by Google Analytics. The cookie is used to store information of how visitors use a website and helps in creating an analytics report of how the website is doing. The data collected including the number visitors, the source where they have come from, and the pages visted in an anonymous form.
Advertisement
Advertisement cookies are used to provide visitors with relevant ads and marketing campaigns. These cookies track visitors across websites and collect information to provide customized ads.
CookieDurationDescription
IDE1 year 24 daysUsed by Google DoubleClick and stores information about how the user uses the website and any other advertisement before visiting the website. This is used to present users with ads that are relevant to them according to the user profile.
test_cookie15 minutesThis cookie is set by doubleclick.net. The purpose of the cookie is to determine if the user's browser supports cookies.
Others
Other uncategorized cookies are those that are being analyzed and have not been classified into a category as yet.
SAVE & ACCEPT
Powered by CookieYes Logo