Germany: Health System Overview - World Health Systems Facts

Life expectancy at birth (years), 2021: 80.5 years
Maternal mortality ratio (per 100,000 live births), 2023: 4
Under-five mortality rate (per 1000 live births), 2023: 3.7
Neonatal mortality rate (per 1000 live births), 2023: 2.3
Tuberculosis incidence (per 100,000 population), 2023: 4.8
Probability of dying from any of cardiovascular disease, cancer, diabetes, chronic respiratory disease between age 30 and exact age 70 (%), 2021: 11.6%
Suicide mortality rate (per 100,000 population), 2021: 12.9
Universal Health Coverage: Service coverage index, 2021: ≥80
Diphtheria-tetanus-pertussis (DTP3) immunization coverage among 1-year-olds (%), 2023: 91%
Measles-containing-vaccine second-dose (MCV2) immunization coverage by the locally recommended age (%), 2023: 93%
Pneumococcal conjugate 3rd dose (PCV3) immunization coverage among 1-year olds (%), 2023: 82%
Human papillomavirus (HPV) immunization coverage estimates among 15 year-old girls (%), 2023: 54%
Density of medical doctors (per 10,000 population), 2015-2023: 45.34
Density of nursing and midwifery personnel (per 10,000 population), 2016-2023: 122.49
Density of dentists (per 10,000 population), 2016-2023: 8.48
Density of pharmacists (per 10,000 population), 2015-2023: 6.71
Domestic general government health expenditure (GGHE-D) as percentage of general government expenditure (GGE) (%), 2022: 20.46%
Prevalence of stunting in children under 5 (%), 2024: 2.2%
Prevalence of wasting in children under 5 (%), 2015-2024: 0.5%
Prevalence of overweight in children under 5 (%), 2024: 3.3%
Prevalence of anaemia in women aged 15-49 years (%), 2023: 14.0%

Source: World health statistics 2025: monitoring health for the SDGs, Sustainable Development Goals. Tables of health statistics by country and area, WHO region and globally. Geneva: World Health Organization; 2025. Licence: CC BY-NC-SA 3.0 IGO.

Health expenditure per capita, USD PPP, 2022
– Government/compulsory: $6,930
– Voluntary/Out-of-pocket: $1,081
– Total: $8,011
Health expenditure as a share of GDP, 2022
– Government/compulsory: 10.9%
– Voluntary/out-of-pocket: 1.7%
Health expenditure by type of financing, 2021
– Government schemes: 11%
– Compulsory health insurance: 75%
– Voluntary health insurance: 1%
– Out-of-pocket: 12%
– Other: 1%
Out-of-pocket spending on health as share of final household consumption, 2021: 3.2%
Price levels in the healthcare sector, 2021 (OECD average = 100): 81
Population reporting unmet needs for medical care, by income level, 2021
– Lowest quintile: 0.3%
– Highest quintile: 0.0%
– Total: 0.1%
Main reason for reporting unmet needs for medical care, 2021:
– Waiting list: 0.0%
– Too expensive: 0.1%
– Too far to travel: 0.0%
Population reporting unmet needs for dental care, by income level, 2021
– Lowest quintile: 0.8%
– Highest quintile: 0.1%
– Total: 0.3%
Population coverage for a core set of services, 2021
– Total public coverage: 89%
– Primary private health coverage: 11%
Population aged 15 years and over rating their own health as bad or very bad, 2021: 12.4%
Population aged 15 years and over rating their own health as good or very good, by income quintile, 2021
– Highest quintile: 78.3%
– Lowest quintile: 51.2%
– Total: 63.0%
Life expectancy at birth, 2021: 80.8
Infant mortality, deaths per 1,000 live births, 2021: 3.0
Maternal mortality rate, deaths per 100,000 live births, 2020: 4.4
Congestive heart failure hospital admission in adults, age-sex standardized rate per 100,000 population, 2021: 363
Asthma and chronic obstructive pulmonary disease hospital admissions in adults, age-sex standardized rate per 100,000 population, 2021: 193
Hospital workforce per 1,000 population, 2021
– Physicians: 2.55
– Nurses and midwives: 6.5
– Healthcare assistants: 0.82
– Other health service providers: 4.13
– Other staff: 3.77
– Total: 17.8
Practicing doctors per 1,000 population, 2021: 4.5
Share of different categories of doctors, 2021
– General practitioners: 16.1%
– Specialists: 77.2%
– Other doctors: 6.8%
Share of foreign-trained doctors, 2021: 13.8% (Note: Data based on nationality (not on place of training).)
Medical graduates per 100,000 population, 2021: 12.4
Practicing nurses per 1,000 population, 2021: 12.0
Share of foreign-trained nurses, 2021: 9.6% (Note: Data based on nationality (not on place of training).)
Nursing graduates per 100,000 population, 2021: 44.2
Ratio of nurses to doctors, 2021: 2.7
Practicing pharmacists per 100,000 population, 2021: 67
Community pharmacies per 100,000 population, 2021: 23
Remuneration of doctors, ratio to average wage, 2021:
– General Practitioners
– Self-employed: 5.04
– Specialists
– Salaried: 3.4
– Self-employed: 5.64
Remuneration of hospital nurses, ratio to average wage, 2018: 1.1
Remuneration of hospital nurses, USD PPP, 2018: $60,000
Hospital beds per 1,000 population, 2021: 7.8
Average length of stay in hospital, 2021: 8.8 days
Average number of in-person doctor consultations per person, 2021: 9.6
CT scanners per million population, 2021: 36
CT exams per 1,000 population, 2021: 160
MRI units per million population, 2021: 35
MRI exams per 1,000 population, 2021: 158
PET scanners per million population, 2021: 2
PET exams per 1,000 population, 2021: 2
Proportion of primary care practices using electronic medical records, 2021: 100%
Expenditure on retail pharmaceuticals per capita, USD PPP, 2021
– Prescription medicines: $886
– Over-the-counter medicines: $120
– Total: $1,006
Expenditure on retail pharmaceuticals by type of financing, 2021:
– Government/compulsory schemes: 81%
– Voluntary health insurance schemes: 0%
– Out-of-pocket spending: 18%
– Other: 0%
Share of the population aged 65 and over, 2021: 22.0%
Share of the population aged 65 and over, 2050: 28.1%
Share of the population aged 80 and over, 2021: 4.8%
Share of the population aged 80 and over, 2050: 10.2%
Adults aged 65 and over rating their own health as good or very good, 2021: 38%
Adults aged 65 and over rating their own health as poor or very poor, by income, 2021
– Lowest quintile: 30%
– Highest quintile: 14%
– Total: 23%
Limitations in daily activities in adults aged 65 and over, 2020
– Some limitations: 21%
– Severe limitations: 21%
Share of adults aged 65 and over receiving long-term care, 2021: 20.5%
Estimated prevalence of dementia per 1,000 population, 2021: 19.3
Estimated prevalence of dementia per 1,000 population, 2040: 24.8
Total long-term care spending as a share of GDP, 2021: 2.5%
Long-term care workers per 100 people aged 65 and over, 2021: 5.5
Share of informal carers among the population aged 50 and over, 2019
– Daily carers: 9%
– Weekly carers: 9%
Share of long-term care workers who work part time or on fixed contracts, 2021
– Part-time: 71%
– Fixed-term contract: 12.3%
Average hourly wages of personal care workers, as a share of economy-wide average wage, 2018
– Residential (facility-based) care: 67%
– Home-based care: 64%
Long-term care beds in institutions and hospitals per 1,000 population aged 65 years and over, 2021
– Institutions: 53.9
Long-term care recipients aged 65 and over receiving care at home, 2021: 81%
Total long-term care spending by provider, 2021
– Nursing home: 46%
– Hospital: 0%
– Home care: 32%
– Households: 21%
– Social providers: 0%
– Other: 1%

Source: OECD (2023), Health at a Glance 2023: OECD Indicators, OECD Publishing, Paris, doi.org/10.1787/7a7afb35-en.

Population, 2021: 83,409
Annual Population Growth Rate, 2020-2030: -0.1%
Life Expectancy at Birth, 2021: 81
Share of Urban Population, 2021: 78%
Annual Growth Rate of Urban Population, 2020-2030 (%): 0.1%
Neonatal Mortality Rate, 2021: 2
Infant Mortality Rate, 2021: 3
Under-5 Mortality Rate, 2021: 4
Maternal Mortality Ratio, 2020: 4
Gross Domestic Product Per Capita (Current USD), 2010-2019: $46,468
Share of Household Income, 2010-2019
– Bottom 40%: 20%
– Top 20%: 40%
– Bottom 20%: 8%
Gini Coefficient, 2010-2019: 30
Palma Index of Income Inequality, 2010-2019: 1.1

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).”
Gini coefficient – Gini index measures the extent to which the distribution of income (or, in some cases, consumption expenditure) among individuals or households within an economy deviates from a perfectly equal distribution. A Gini index of 0 represents perfect equality, while an index of 100 implies perfect inequality.
Palma index of income inequality – Palma index is defined as the ratio of the richest 10% of the population’s share of gross national income divided by the poorest 40%’s share.

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.

Population, Midyear 2022: 83,369,843
Population Density (Number of Persons per Square Kilometer): 239.18
Life Expectancy at Birth, 2022 (per 1,000 live births): 80.99
Infant Mortality Rate, 2022 (per 1,000 live births): 2.96
Under-Five Mortality Rate, 2022: 3.52
Projected Population, Midyear 2030: 82,762,676
Percentage of Total Population Aged 65 and Older, Midyear 2022: 22.41%
Projected Percentage of Total Population Aged 65 and Older, Midyear 2030: 26.39%
Projected Percentage of Total Population Aged 65 and Older, Midyear 2050: 30.48%

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.

Current health expenditure (CHE) per capita in US$, 2022: $6,182.34

Source: Global Health Observatory. Current health expenditure (CHE) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Out-of-pocket expenditure (OOP) per capita in US$, 2022: $663.71

Source: Global Health Observatory. Out-of-pocket expenditure (OOP) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Out-of-pocket expenditure as percentage of current health expenditure (CHE) (%), 2022: 10.74%

Source: Global Health Observatory. Out-of-pocket expenditure as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic private health expenditure (PVT-D) as percentage of current health expenditure (CHE) (%), 2022: 19.67%

Source: Global Health Observatory. Domestic private health expenditure (PVT-D) as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic private health expenditure (PVT-D) per capita in US$, 2022: $1,216.20

Source: Global Health Observatory. Domestic private health expenditure (PVT-D) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic general government health expenditure (GGHE-D) as percentage of current health expenditure (CHE) (%), 2022: 80.33%

Source: Global Health Observatory. Domestic general government health expenditure (GGHE-D) as percentage of current health expenditure (CHE) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic general government health expenditure (GGHE-D) as percentage of gross domestic product (GDP) (%), 2022: 10.13%

Source: Global Health Observatory. Domestic general government health expenditure (GGHE-D) as percentage of gross domestic product (GDP) (%). Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Domestic general government health expenditure (GGHE-D) per capita in US$, 2022: $4,966.15

Source: Global Health Observatory. Domestic general government health expenditure (GGHE-D) per capita in US$. Geneva: World Health Organization. Last accessed Jan. 23, 2025.

Annual household out-of-pocket payment in current USD per capita, 2021: $756

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed May 13, 2023.

Total Health Spending In US$ PPP Per Capita (2022): $8,011

(Note: “Health spending measures the final consumption of health care goods and services (i.e. current health expenditure) including personal health care (curative care, rehabilitative care, long-term care, ancillary services and medical goods) and collective services (prevention and public health services as well as health administration), but excluding spending on investments. Health care is financed through a mix of financing arrangements including government spending and compulsory health insurance (“Government/compulsory”) as well as voluntary health insurance and private funds such as households’ out-of-pocket payments, NGOs and private corporations (“Voluntary”). This indicator is presented as a total and by type of financing (“Government/compulsory”, “Voluntary”, “Out-of-pocket”) and is measured as a share of GDP, as a share of total health spending and in USD per capita (using economy-wide PPPs).”

Source: OECD (2023), Health spending (indicator). doi: 10.1787/8643de7e-en (Accessed on 24 August 2023).

“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.

“In Germany, 88 percent of the population is covered by statutory health insurance, which is financed by financially and organizationally independent statutory health insurance funds, and 9 percent of the population is privately insured.¹⁵ The guiding principle of the German statutory health insurance system is solidarity regarding both income and provision of services: All insured people contribute a share of their income, irrespective of their health risk, and people are entitled to benefits according to their health needs, irrespective of their socioeconomic status, ability to pay, or location.¹⁶ All employed people earning less than the opt-out threshold, people receiving welfare benefits, and pensioners have mandatory statutory health insurance, and their nonearning dependents are insured free of charge. People with high income and self-employed people can purchase private health insurance or keep the statutory health insurance. Coverage of services is roughly the same in both systems, apart from certain newly launched drugs, which are paid for by private insurance. There is no restriction on patients’ choice of hospitals, and patient copays for hospital stays do not differ across hospitals.”

Source: Esra Eren Bayindir and Jonas Schreyögg. Public Reporting Of Hospital Quality Measures Has Not Led To Overall Quality Improvement: Evidence From Germany. Health Affairs 2023 42:4, 566-574

“The German health system has a complex governance structure. The federal government defines only the legal framework, while regulatory details are specified in directives issued by the Federal Joint Committee – the highest self-governing decision-making body in the country. The Committee consists of representatives of associations of sickness funds, physicians, dentists and hospitals, as well as three independent members (plus patient representatives without voting rights). It takes decisions on SHI benefits, reimbursement systems and quality assurance.

“The states (Bundesländer) supervise the self-governing bodies at the regional level and are responsible for hospital planning and investments, as well as medical education. They are also responsible for public health services and the running of public health offices, which gained in importance during the COVID-19 crisis. At the same time, the crisis revealed the challenges faced by federal systems in coordinating and managing the pandemic. Governance mechanisms have been put in place to enable rapid, cross-state measures to respond to the crisis through ordinance authorisations, particularly by the Federal Ministry of Health (Box 1).”

“The German system provides universal population coverage either through social health insurance (SHI) (almost 90% of the population) or substitutive VHI [Voluntary Health Insurance]. As OOP [Out-Of-Pocket] policies of substitutive VHI vary widely (and data is largely unavailable), we focus on SHI. OOP spending in Germany is related to both direct payments for services not covered by SHI (e.g., over-the-counter drugs) and cost-sharing for SHI covered services, but the relative importance of cost-sharing versus direct payments is not known because of the health system’s accounting methods. OOP spending above reference prices for dental care and medical aids can be substantial; for example, reference prices for dental care cover only about 50% of the costs of standard care. Cost-sharing requirements increased in 2004 for such things as prescription drugs, inpatient care, and physician and dental care, while at the same time adult eyeglasses were excluded from coverage. Since these increased requirements became effective in 2004 they do not affect the average growth rate in the 2004–2014 period and therefore do not contradict the observed drop in average growth in 2004–2014 compared to the 1994–2004 period. The most plausible explanation for the low growth in this period is the fact that in 2013, co-payments for physician visits were discontinued. The most important protection mechanism against OOPs is the exemption of children under 18 years of age and a maximum cost-sharing limit of 2% of annual income (or 1% for patients with severe chronic conditions). This has remained largely unchanged over the study period.”

Rice, Thomas et al. “Revisiting out-of-pocket requirements: trends in spending, financial access barriers, and policy in ten high-income countries.” BMC health services research vol. 18,1 371. 18 May. 2018, doi:10.1186/s12913-018-3185-8.

“In the aftermath of the COVID-19 pandemic, the German federal government recently orchestrated a fundamental change to its public health infrastructure. This reconstruction centers around the founding of a National Institute for Prevention and Education in Medicine (Bundesinstitut für Prävention und Aufklärung in der Medizin, BIPAM) at the cost of two federal institutions, the Robert Koch-Institute (RKI) and the Federal Center for Health Education (Bundeszentrale für gesundheitliche Aufklärung, BzGA). Thus, the Federal Ministry of Health (Bundesministerium für Gesundheit, BMG) plans to dissolve the BzGA and integrate its personnel into the future BIPAM. Further, all RKI research and surveillance activities related to non-communicable diseases, including AI methods development will be transferred into the BIPAM. The RKI responsibilities will solely focus on infectious diseases. According to announced plans of the BMG the primary objective for establishing the BIPAM is to address non-communicable diseases and enhance overall population health. However, the medical specialist training for public health remains non-academic at a state institution. Simultaneously the BMG already replaced two thirds of experts of the permanent commission on vaccination (Ständige Impfkommission, STIKO) and determined new procedures for appointing future expert commissioners. With these changes, Germany embarks on an extraordinary reshuffling of its national public health organizations and responsibilities, by fundamentally separating all issues around non-communicable diseases from those of infectious diseases. Germany’s unraveled research tasks of public health authorities however remains unmet. Thus, 2024 marks a pivotal caesura for public health in the modern history of Germany.”

Source: Savaskan N, Lampl BMJ, Yavuz M, Tinnemann P. Germany’s national public health gets reorganized: A new institute shall take center stage. Health Policy. 2024;145:105084. doi:10.1016/j.healthpol.2024.105084

“The German health system and its governance is highly complex. It is the only country in Europe with coexisting SHI [Statutory Health Insurance] and substitutive PHI [Private Health Insurance]. Both schemes are separated along different organizational, regulative and financial lines (Figure 2.1). Care sectors are also separated in terms of organization, governance and financing. Due to separate legislation for individual sectors within public health, ambulatory and inpatient care, as well as in long-term care, there is strong fragmentation of service provision (Figures 2.1 and 2.2).

“Health insurance is compulsory for all citizens and permanent residents, with SHI constituting the main source of financing health care. The multi-payer SHI insurance scheme covered 72.8 million people or 87.7% of the population in 2018. Employees above an opt-out threshold of income, € 62 550 in 2020, and certain professional groups, e.g. self-employed or civil servants, can opt to enroll in substitutive PHI. Thus, 8.7 million people (or 10.5% of the population) were covered by substitutive PHI (Bundesministerium für Gesundheit (BMG), 2019d; Statistisches Bundesamt, 2019b; Verband der privaten Krankenversicherung, 2019a) (see Section 3.3.1 Coverage for more detail). Another unique feature of the German health care system is that the vast majority of providers serve both insured populations. The few exemptions that are accessible only to those insured under substitutive PHI represent less than 1% of total hospitals in 2018 (Statistisches Bundesamt, 2020g).”

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 insurance coverage is mandatory for the entire population. Coverage is virtually universal and less than 1% of the population is not insured. Some groups of people can choose between publicly financed coverage provided through the statutory health insurance scheme and privately financed substitutive coverage provided by private insurers. Access to substitutive private coverage is restricted to civil servants, self-employed individuals and high-income employees (the annual earnings threshold was €50,850 in 2012). These groups may opt out of the statutory scheme, but once they do so the return options are limited. For example, employees may only return to the statutory scheme when their earnings fall below the threshold. Individuals with substitutive private coverage who are older than 55 years are prohibited from returning to the statutory scheme.”

Source: Stefan Greß. “Germany.” In Voluntary health insurance in Europe: Country experience [Internet]. Sagan A, Thomson S, editors. Copenhagen (Denmark): European Observatory on Health Systems and Policies; 2016. Observatory Studies Series, No. 42.

“The archetypal Bismarck model is the traditional system of Germany, financed by multiple insurers, with employer-based schemes supplemented by the state, in which providers are privately owned and patients have direct access to specialists.”

Source: Bevan G, Helderman JK, Wilsford D: Changing choices in health care: implications for equity, efficiency and cost. Health Econ Policy Law. 2010, 5 (3): 251-67. 10.1017/S1744133110000022.

“The German health care system is notable for two essential characteristics: 1) the sharing of decision-making powers between states, federal government, and self-regulated organizations of payers and providers; and 2) the separation of SHI (including the social LTCI) and PHI (including the private LTCI). SHI and PHI (as well as the two long-term care insurance systems) use the same providers—that is, hospitals and physicians treat both statutorily and privately insured patients, unlike those in many other countries.

“Within the legal framework set by the Federal Ministry of Health, the Federal Joint Committee has wide-ranging regulatory power to determine the services to be covered by sickness funds and to set quality measures for providers (see below). To the extent possible, coverage decisions are based on evidence from health technology assessments and comparative-effectiveness reviews. The Federal Joint Committee is supported by the Institute for Quality and Efficiency (IQWiG), a foundation legally charged with evaluating the cost-effectiveness of drugs with added therapeutic benefits, and the Institute for Quality and Transparency (IQTiG), which is responsible for intersectoral quality assurance. It has 13 voting members: five from the Federal Association of Sickness Funds, two each from the Federal Association of SHI Physicians and the German Hospital Federation, one from the Federal Association of SHI Dentists, and three who are unaffiliated. Five patient representatives have an advisory role but no vote. Representatives of patient organizations have the right to participate in different decision-making bodies—for example, the subcommittees of the Federal Joint Committee.

“The Federal Association of Sickness Funds works with the Federal Association of SHI Physicians and the German Hospital Federation to develop the SHI ambulatory care fee schedule and the DRG catalogue, which are then adopted by bilateral joint committees.”

Source: Commonwealth Fund. International Health System Profiles: Germany. Last accessed Sept. 30, 2019.

“The Federal Ministry of Health (“Bundesministerium für Gesundheit” – BMG) is responsible for policy-making at the federal level. Its tasks include developing laws and drawing up administrative guidelines for the self-governing activities within the health care system. The Ministry of Health directs a number of institutions and agencies responsible for dealing with higher-level issues of public health, such as the Federal Institute for Drugs and Medical Devices (“Bundesinstitut für Arzneimittel und Medizinprodukte” – BfArM) and the Paul Ehrlich Institute (PEI). The Federal Institute for Drugs and Medical Devices makes decisions concerning the approval of pharmaceuticals. The Paul Ehrlich Institute is responsible for approving vaccines.

“When it comes to matters concerning statutory health insurance, the Federal Joint Committee (G-BA) is the highest decision-making body within the self-governing health care system. It includes members representing doctors, dentists, psychotherapists, the statutory insurers, hospitals and patients. As the central entity of federal-level self-governance, the Federal Joint Committee makes decisions concerning which medical services will be covered by the statutory insurers and what form that coverage will take.”

Source: InformedHealth.org [Internet]. Cologne, Germany: Institute for Quality and Efficiency in Health Care (IQWiG); 2006-. Health care in Germany: The German health care system. 2015 May 6 [Updated 2018 Feb 8]. Last accessed August 19, 2019.

“The Federal Joint Committee (G-BA) is a public legal entity comprising the four leading umbrella organizations of the self-governing German healthcare system: the National Associations of Statutory Health Insurance Physicians and Dentists, the German Hospital Federation, and the Central Federal Association of Health Insurance Funds. In addition to these four pillar organizations, patient representatives also participate in all sessions; they are entitled to put topics on the agenda, but not to vote.”

Source: The Federal Joint Committee: Who we are and what we do. Gemeinsame Bundesausschuss (Federal Joint Committee). Last accessed September 30, 2019.

“The framework for health care in Germany is based on central decision making:

“1) Legislation established by the parliament,
“2) Decrees issued by the Ministry of Health,
“3) Directives issued by the G-BA under supervision of the ministry, and
“4) Contracts between self-governing organizations under supervision of the ministry.

“There is no competition on products on services between the funds. All provide the same services as defined by the G-BA (Gemeinsamer Bundesausschuss) or the different umbrella organizations of the SHFs (referred to in the following the Statutory Health Insurer’s organizations (SHIs). Private insurance covers nearly the same services but allows additional benefits (e.g. first class service) – there is competition between private insurers. Since 2004, decision-making in statutory health insurance has been integrated into a trans-sector federal joint committee that is supported by an independent institute for quality and efficiency in health care, the German IQWiG. Since 2008, according to the new Competition Enhancement Act, the IQWiG has to evaluate the cost-benefit ratio of pharmaceuticals in Germany based on international accepted guidelines in evidence based medicine and in health economics.”

Source: ISPOR—The Professional Society for Health Economics and Outcomes Research. Global Health Technology Assessment Road Map: Germany – Pharmaceutical. Updated June 2009. Last accessed Oct. 2, 2019.

“The German health care system is divided into three main areas: outpatient care, inpatient care (the hospital sector), and rehabilitation facilities.

“The institutions responsible for running the health care system include the associations and representatives of various providers and professions, health insurers, regulatory bodies, the Federal Ministry of Health, patient organizations and self-help groups.

“The basic principles of the health care system

“The health care system in Germany is based on four basic principles:

“Compulsory insurance: Everyone must have statutory health insurance (“gesetzliche Krankenversicherung” – GKV) provided that their gross earnings are under a fixed limit (“Versicherungspflichtgrenze”). Anyone who earns more than that can choose to have private insurance (“private Krankenversicherung” – PKV).

“Funding through insurance premiums: Health care is financed mostly from the premiums paid by insured employees and their employers. Tax revenue surpluses also contribute. To give you an idea of what this means: State-funded health care systems like those in Great Britain or Sweden draw on tax revenue. In market-oriented systems such as that in the United States, many people have to carry the costs of treatment and loss of earnings due to illness themselves, or have to get private health insurance.

“Principle of solidarity: In the German health care system, statutory health insurance members jointly carry the individual risks of the costs of medical care in the event of illness. Everyone covered by statutory insurance has an equal right to medical care and continued payment of wages when ill – regardless of their income and premium level. The premiums are based on income. This means that the rich can help the poor, and the healthy can help the ill. However, these premiums are only calculated based on a percentage scale up to a certain income level (“Beitragsbemessungsgrenze”). Anyone earning more than this amount pays the same maximum premium.

“Principle of self-governance: While the German state sets the conditions for medical care, the further organization and financing of individual medical services is the responsibility of the self-governing bodies within the health care system. These are made up of members representing doctors and dentists, psychotherapists, hospitals, insurers and the insured people. The Federal Joint Committee (“Gemeinsamer Bundesausschuss” or G-BA – please also see below: “Structure and institutions of the health care system”) is the highest entity of self-governance within the statutory health insurance system.”

Germany: Health System Overview - National Policies - World Health Systems Facts

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Page last updated July 18, 2025 by Doug McVay, Editor.