Total Health Spending, USD PPP Per Capita (2019): $6,646

(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 (2021), Health spending (indicator). doi: 10.1787/8643de7e-en (Accessed on 20 January 2021).
https://data.oecd.org/healthres/health-spending.htm

Current Health Expenditure Per Capita (USD) (2016): $4,714
Current Health Expenditure as Percentage of Gross Domestic Product (%) (2016): 11.1%
Domestic General Government Health Expenditure as Percentage of General Government Expenditure (%) (2016): 21.4%
Population with household expenditures on health greater than 10% of total household expenditure or income (2009-2015) (%): NA
Population with household expenditures on health greater than 25% of total household expenditure or income (2009-2015) (%): NA

Source: World health statistics 2019: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization; 2019. Licence: CC BY-NC-SA 3.0 IGO.
https://apps.who.int/iris/bitstream/handle/10665/324835/9789241565707-eng.pdf
https://www.who.int/gho/publications/world_health_statistics/2019/en/

Annual household out-of-pocket payment, constant (2016) PPP, per capita (USD) (2016): $629

Source: Global Health Expenditure Database. Health expenditure series. Geneva: World Health Organization. Last accessed Jan. 10, 2020.
http://apps.who.int/nha/database/

Out-of-Pocket Spending as Share of Final Household Consumption (%) (2017): 2.7%

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

Remuneration of Doctors, Ratio to Average Wage (2017)
General Practitioners: 4.4
Specialists: 3.5 (Salaried); 5.4 (Self-Employed)

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

Remuneration of Hospital Nurses, Ratio to Average Wage (2017): 1.1
Remuneration of Hospital Nurses, USD PPP (2017): $53,600

Source: OECD (2019), Health at a Glance 2019: OECD Indicators, OECD Publishing, Paris, https://doi.org/10.1787/4dd50c09-en.
https://www.oecd.org/health/health-systems/health-at-a-glance-19991312.htm

“Although SHI [Statutory Health Insurance] dominates the German discussion on health care expenditure and reform(s), its actual contribution to overall health expenditure was only 57.4% in 2012 (Statistisches Bundesamt, 2014b; Table 3.3; Fig. 3.5). The other three pillars of social insurance contributed an additional 10.7% of total health expenditure: statutory retirement insurance with 1.4% (mainly for medical rehabilitation), statutory insurance for occupational accidents and disease with 1.6%, and statutory long-term care insurance with 7.7%. Governmental sources contributed another 4.8%. Altogether, public sources accounted for 72.9% of total expenditure on health. Private sources accounted for 27.1% of total expenditure. Among them, private households financed 13.5% (figures include expenditure by nongovernmental organizations, which is negligible). Private insurers financed 9.3%, which includes expenditure for substitutive/comprehensive health insurance, complementary health insurance as well as long-term care insurance. Employers paid 4.3%: ironically this “private” expenditure is mainly for expenses reimbursed by public employers for their civil servants and may explain discrepancies between German and international sources regarding the size of the private share of total health care expenditure.”

Source: Busse R, Blümel M. Germany: health system review. Health Systems in Transition, 2014, 16(2):1–296.
https://apps.who.int/iris/handle/10665/130246

“Cost-sharing and out-of-pocket spending: Out-of-pocket spending accounted for 13.2 percent of total health spending in 2014, mostly on nursing homes, pharmaceuticals, and medical aids.⁹

“Copayments include EUR5.00 to EUR10.00 (USD6.36 to USD12.72) per outpatient prescription, EUR10.00 per inpatient day for hospital and rehabilitation stays (for the first 28 days per year), and EUR5.00 to EUR10.00 for prescribed medical devices. Sickness funds offer selectable tariffs with a range of deductibles and no-claims bonuses. Preventive services do not count toward the deductible. SHI-contracted physicians are not allowed to charge above the fee schedule for services in the SHI benefit catalogue. However, a list of “individual health services” outside the comprehensive range of SHI coverage may be offered to patients paying out of pocket.

“Safety nets: Children under 18 years of age are exempt from cost-sharing. For adults, there is an annual cap on cost-sharing equal to 2 percent of household income; part of a household’s income is excluded from this calculation for additional family members. About 0.3 million of those insured under SHI exceeded the 2 percent cap in 2014 and were exempted from further cost-sharing. The cap is lowered to 1 percent of annual gross income for qualifying chronically ill people; to qualify, those people have to demonstrate that they attended recommended counseling or screening procedures prior to becoming ill. Nearly 6.3 million people, or around 9 percent of all the SHI-insured, benefited from this regulation in 2014.¹⁰ Unemployed people contribute to SHI in proportion to their unemployment entitlements. For the long-term unemployed, government contributes on their behalf.”

Source: Commonwealth Fund. International Health System Profiles: Germany. From the web, last accessed Sept. 30, 2019.
https://international.commonwealthfund.org/countries/germany/

“The 132 sickness funds collect contributions and transfer these to the Central Reallocation Pool (Gesundheitsfonds; literally, “Health Fund”).² Contributions increase proportionally with income to an upper threshold (a monthly income of €4050 in 2014). Since 2009 there has been a uniform contribution rate (15.5% of income). Resources are then redistributed to the sickness funds according to a morbidity-based risk-adjustment scheme (morbiditätsorientierter Risikostrukturausgleich; often abbreviated to Morbi-RSA), and funds have to make up any shortfall by charging a supplementary premium.

“Sickness funds pay for health care providers, with hospitals and physicians in ambulatory care (just ahead of pharmaceuticals) being the main expenditure blocks. Hospitals are financed through “dual financing”, with financing of capital investments through the Länder and running costs through the sickness funds, private health insurers and self-pay patients – although the sickness funds finance the majority of operating costs (including all costs for medical goods and personnel). Financing of running costs is negotiated between individual hospitals and Länder associations of sickness funds, and primarily takes place through diagnosis-related groups (Diagnose-bezogene Fallpauschale; DRGs). Public investment in hospital infrastructure has declined by 22% over the last decade and is not evenly distributed; in 2012, hospitals in the western part of Germany received 83% of such public investment.

“Payment for ambulatory care is subject to predetermined price schemes for each profession (one for SHI services and one for private services). Payment of physicians by the SHI is made from an overall morbidity-adjusted capitation budget paid by the sickness funds to the regional associations of SHI physicians (Kassenärztliche Vereinigungen), which they then distribute to their members according to the volume of services provided (with various adjustments). Payment for private services is on a fee-for-service basis using the private fee scale, although individual practitioners typically charge multiples of the fees indicated.”

Source: Busse R, Blümel M. Germany: health system review. Health Systems in Transition, 2014, 16(2):1–296.
https://apps.who.int/iris/handle/10665/130246

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 Nov. 15, 2020 by Doug McVay, Editor.