German Health System Overview
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Germany’s COVID-19 Strategy
Life Expectancy at Birth, 2022: 80.99
Infant Mortality Rate, 2022 (per 1,000 live births): 2.96
Under-Five Mortality Rate, 2022 (per 1,000 live births): 3.52
Source: United Nations, Department of Economic and Social Affairs, Population Division (2023). Data Portal, custom data acquired via website. United Nations: New York. Accessed 12 May 2023.
Life Expectancy at Birth (2019): 81.7
Maternal Mortality Ratio (per 100,000 live births) (2017): 7
Neonatal Mortality Rate (per 1,000 live births) (2020): 2
Probability of Dying from any of Cardiovascular Disease, Cancer, Diabetes, Chronic Respiratory Diseases Between Age 30 and Exact Age 70 (%) (2019): 12.1%
Source: World health statistics 2022: monitoring health for the SDGs, sustainable development
goals. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.
Neonatal Mortality Rate, 2021: 2
Infant Mortality Rate, 2021: 3
Under-5 Mortality Rate, 2021: 4
Maternal Mortality Ratio, 2020: 4
Note: “Under-5 mortality rate – Probability of dying between birth and exactly 5 years of age, expressed per 1,000 live births.
“Infant mortality rate – Probability of dying between birth and exactly 1 year of age, expressed per 1,000 live births.
“Neonatal mortality rate – Probability of dying during the first 28 days of life, expressed per 1,000 live births.”
“Maternal mortality ratio – Number of deaths of women from pregnancy-related causes per 100,000 live births during the same time period (modelled estimates).”
Source: United Nations Children’s Fund, The State of the World’s Children 2023: For every child, vaccination, UNICEF Innocenti – Global Office of Research and Foresight, Florence, April 2023.
Maternal Deaths Per 100,000 Live Births, 2020: 4
Source: Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. Geneva: World Health Organization; 2023. Licence: CC BY-NC-SA 3.0 IGO.
Adverse events in hip and knee surgeries: post-operative pulmonary embolism (PE) or deep vein thrombosis (DVT), 2019 (Rate per 100,000 Discharges):
— PE: 347.2; DVT: 329
Obstetric trauma, vaginal delivery with and without instrument, 2019 (Crude rate per 100,000 hospital discharges):
— With Instrument: 6.6; Without Instrument: 1.5
Asthma hospital admission in adults, 2019 (Age-sex standardized rates per 100,000 population): 31.5
Chronic obstructive pulmonary disorder (COPD) hospital admission in adults, 2019 (Age-sex standardized rates per 100,000 population): 249.6
Congestive heart failure (CHF) hospital admission in adults, 2019 (Age-sex standardized rates per 100,000 population): 393.3
Diabetes hospital admission in adults, 2019 (Age-sex standardized rates per 100,000 population): 206.1
Source: OECD (2021), Health at a Glance 2021: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/ae3016b9-en.
“Life expectancy at birth in Germany has increased by almost three years since 2000 (from 78.3 years to 81.1 years in 2020), but most of this gain occurred between 2000 and 2010, and the increase was only eight months between 2010 and 2019. Most other EU Member States achieved greater progress in life expectancy during this period – particularly countries in the central and eastern part of Europe, as well as Denmark and Ireland. As with most other EU countries, life expectancy showed a temporary decrease between 2019 and 2020 owing to the impact of the COVID-19 pandemic: in Germany, this reduction was 2.5 months compared to an EU average of nearly 8.5 months. German life expectancy is now half a year above the EU average (Figure 1) but still around 1.5 years lower than the rate in EU countries with the highest levels.
“A substantial gender gap in life expectancy persists in Germany: women can expect to live 4.7 years longer than men (83.7 compared to 79 years), but this gap is slightly smaller than the EU average (5.6 years).”
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.
“Life expectancy at birth in Germany has increased by 2.7 years since 2000 and reached 81.0 years in 2018 (Table 1.3). Although life expectancy is slightly above the EU average of 80.9 years, it has increased more slowly than in most other EU countries since 2000 and is lower than in all other western European countries (OECD/European Observatory on Health Systems and Policies, 2019). As in other countries there is a gender gap in life expectancy and women born in 2018 are expected to live on average 4.7 years longer than men. The gender gap in life expectancy has narrowed by 1.4 years since 2000. Life expectancy after the age of 65 increased from 15.8 to 18.0 years for men and from 19.6 to 21.1 years for women between 2000 and 2018, i.e. the gender gap has narrowed in the elderly as well (Table 1.3).”
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.
“Table 1.3 shows that the total mortality rate in Germany has been steadily declining since 2000. This positive development is also reflected in the increases seen in life expectancy at birth. According to Eurostat data, the standardized death rate (SDR) for all causes of death was higher than the EU average in 2016 (1017 in Germany compared to 998 per 100,000 population across the EU), with the relative difference being smaller for younger people compared to older ones, and for men compared to women. The two most common causes of death by far in Germany in 2017 were diseases of the circulatory system (accounting for 37% of all deaths) and malignant neoplasms (cancers) (24%), followed by diseases of the respiratory system (7%), Alzheimer’s and other dementias (5%), and diseases of the digestive system (4%).
“Diseases of the circulatory system have decreased sharply since 2000, mostly attributable to the decline in mortality caused by ischaemic heart disease. In 2000 there were 248 deaths per 100,000 population due to ischaemic heart diseases with a considerably higher mortality rate among males (SDR 334 per 100,000 population) than among females (SDR 195 per 100,000 population). While this mortality rate decreased by 44% for both genders (to 139 per 100,000 population), 40% for men (to 199 per 100,000 population) and 50% for women (to 98 per 100,000 population) up to 2017, it is still considerably higher than the EU average (162 males and 86 females per 100,000 population).
“Mortality due to malignant neoplasms also decreased over this period, particularly with regard to cervical and breast cancer. Lung cancer is the most frequent cause of cancer deaths, accounting for 20% of all cancer deaths. While lung cancer mortality has decreased in men by 9% since 2009, this indicator has increased in woman by 20%, mainly due to changes in smoking habits (see below). Diseases of the respiratory system are the third leading cause of death. While the mortality rate is considerably higher in males (100 per 100,000 population) than females (54 per 100,000 population), it is lower than the EU average as a whole and for both genders.
“Strikingly, an increase of 76% can be observed in the age-standardized death rates for Alzheimer’s and other dementias for both genders since 2010. However, this rise reflects both the ageing German population and improved identification and recording of these diseases as causes of death.”
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.
“A measure to assess the contribution of health care to population health is the concept of “amenable mortality”. Amenable mortality reflects premature deaths that should not occur in the presence of timely and effective health care. Based on the WHO mortality database, amenable mortality has declined in all EU countries since 2000, albeit to varying degrees. In Germany the amenable mortality rate decreased from 131.5 deaths per 100,000 population in 2000 to 81.8 deaths per 100 000 population in 2017 (Figure 7.7), but it still accounts for 23.3% of total mortality under the age of 75 and for both sexes combined (Eurostat, 2019). Amenable mortality in Germany is significantly lower than the EU average (122.4 deaths per 100,000 population), but higher than in the selected neighbouring countries Switzerland (50.9), France (57.3), the Netherlands (63.2), Austria (71.7) and Denmark (74.7) (Figure 7.7).
“Another measure to assess health that may be attributed to the health system is the indicator “preventable mortality”. This concept includes deaths which could have been avoided by public health interventions focusing on the wider determinants of public health, such as behaviour and lifestyle factors, socioeconomic status and environmental factors as well. In 2017 Germany could have prevented 51.3 deaths per 100,000 population through effective public health interventions, compared to 68.6 in 2000 (-25.2%). Again, Germany performs better than the EU average (56.1 per 100,000 population), but preventable mortality is higher than in the selected neighbouring countries Switzerland (34.9), the Netherlands (45.3), Austria (48.9) and France (49.9), and is only lower than in Denmark (54.5 per 100,000 population) (Figure 7.7).
“Eurostat data differ slightly from the WHO mortality database – due to differences in how amenable and preventable mortality are conceptualized – and are estimated at 154.8 preventable deaths per 100,000 population and 85.8 amenable deaths per 100,000 population in 2017. Compared to the selected neighbouring countries, Germany has the highest number of amenable deaths and the third highest preventable mortality rate in 2017 (Figure 7.8). Looking at the causes of amenable mortality, ischemic heart disease is the main driver in Germany, accounting for 22% of all amenable deaths in 2017 (18.9 per 100,000 population), followed by colorectal cancer (14.9% or 12.8 per 100 000 population), breast cancer (13.1% or 11.2 per 100,000 female population), stroke (7.9% or 6.8 per 100,000 population), pneumonia (4.6% or 4.0 per 100,000 population) and diabetes (4.4% or 3.8 per 100,000 population) (Eurostat, 2020a). Lung cancer is the leading cause of preventable mortality in Germany. In 2017 there were 34.8 deaths per 100,000 population, making lung cancer responsible for 28.3% of all preventable deaths. Among the comparator countries, this rate is higher in France (35.7 per 100,000 population), Denmark (38.6 per 100,000 population) and the Netherlands (39.1 per 100,000 population). Ischemic heart disease, which causes both amenable and preventable mortality, is the second leading cause (22% or 18.9 per 100,000 population), followed by alcohol-related diseases (9.8% or 15.2 per 100,000 population), and chronic lower respiratory diseases (10.5% or 16.2 per 100,000 population) (Figure 7.8).”
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.
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Page last updated May 14, 2023 by Doug McVay, Editor.
