Healthcare in Germany: Overview

Germany has a comprehensive healthcare system. Almost everyone has access to many medical services. On average, people here visit a doctor often.

In 2014, 328 billion euros were spent on healthcare. That is 11.2% of the gross domestic product. Statutory health insurance received 192 billion euros of this.

Over 5.2 million people work in the healthcare system. This includes 1 million carers and 520,000 geriatric nurses. There are also 430,000 doctors.

There are challenges, such as high hospitalisation rates for diabetes and heart disease. Nevertheless, life expectancy in Germany is 81.2 years. This is just below the EU average.

Basic principles of the German healthcare system

The German healthcare system is based on solidarity. All those with statutory health insurance bear the costs of illnesses together. Around 90 per cent of Germans, i.e. around 72.8 million people, are insured with a statutory health insurance fund.

The costs are mainly financed by contributions from citizens and their employers as well as tax revenues.

Free choice of doctor for insured persons

An important aspect of the system is the free choice of doctor. Insured persons are free to choose which doctor or dentist they visit. This freedom helps to build the best possible relationship of trust with a doctor.

Treatment obligation for doctors

Doctors in Germany must treat every insured person. This applies regardless of insurance status or income. This means that all citizens have access to appropriate medical care.

There are only exceptions in some cases, such as overwork or lack of expertise.

Outpatient care and medical centres

In Germany, there are many medical services outside of hospitals. Doctors, psychotherapists and dentists play a major role. They prescribe medication and help with physiotherapy.

GPs and paediatricians as the first point of contact

GPs and paediatricians are often the first people to be consulted. They know the patient's medical history well. If necessary, they can order further examinations or refer you to a specialist.

Regular training ensures that they are always up to date. This enables them to provide a high standard of care.

Referral to specialists and psychotherapists

Specialised illnesses or in-depth diagnostics often require a referral. GPs send patients to specialists such as gynaecologists or orthopaedists. There are also psychotherapists for psychological problems.

The co-operation between GPs and specialists ensures comprehensive care.

Medical on-call service outside consultation hours

The medical on-call service can be reached by dialling 116 117. Doctors from various specialities help with urgent problems. This relieves the pressure on hospital emergency departments.

Rescue service for emergencies

For life-threatening situations such as heart attacks, the ambulance service can be contacted on 112. Paramedics and emergency doctors provide rapid assistance. Modern ambulances are equipped with top equipment.

Non-physician healthcare professionals and their role in healthcare provision

Non-physician healthcare professionals such as physiotherapists, speech therapists, midwives and nurses are very important in healthcare. They help to treat patients comprehensively. Their training is strictly regulated and requires specialised knowledge and practical skills.

Physiotherapists help to overcome movement restrictions. They use exercises and therapies to relieve pain and promote healing. Speech therapists work with patients who have speech or language disorders. They improve communication skills and make everyday life easier.

Midwives support women during pregnancy, labour and birth. They offer care and advice. Carers look after patients in hospitals, nursing homes or at home.

Doctors and non-medical healthcare professionals work closely together. They provide comprehensive care. A prescription is required for some treatments, such as physiotherapy. This results in individualised therapy plans and the best treatment results.

With increasing life expectancy and demographic change, non-medical healthcare professions are becoming increasingly important. They improve quality of life, promote independence and offer needs-based care. They are not only medically active, but also important contacts and confidants.

Healthcare for people with statutory and private health insurance

In Germany, around 90% of the population has statutory health insurance. Around 10% have private health insurance. At the end of 2023, over 74 million people had statutory health insurance, 58 million of whom were contributors. Around 8.7 million people were fully insured in private health insurance at this time.

Billing with the health insurance company for people with statutory health insurance

People with statutory health insurance show their insurance card to the doctor. Billing takes place directly between the practice and the health insurance company. Co-payments are incurred for services such as high-quality dentures or physiotherapy.

The amount of the co-payments is set by law. In cases of hardship, the co-payment can be reduced or waived.

Self-payment and reimbursement for privately insured persons

Privately insured persons pay the treatment costs themselves. They then submit the invoice to their insurance company. Reimbursement depends on the contract and tariff.

If you change insurers, you will have to pay additional premiums. The surcharge for the second month without insurance is one month's premium. It can amount to up to five additional monthly premiums.

Premiums for private health insurance are tax-deductible. This also applies to co-insured family members. The maximum allowance for the needs test is limited to half of the contribution in the basic tariff. From 1 January 2024, this will be 421.76 euros.

Recipients of citizen's allowance or social assistance are entitled to a subsidy towards insurance contributions under certain conditions.

Historical development of the German healthcare system

The German healthcare system has its roots in the Middle Ages and industrialisation. Medieval guilds already provided social security for craftsmen and their families. With industrialisation, the first health insurance funds for factory workers were established.

An important milestone was Bismarck's social legislation at the end of the 19th century. Chancellor Otto von Bismarck standardised social security on a legal basis.

Introduction of health insurance and other branches of social insurance

In 1883, health insurance was introduced as the first branch of social insurance. At first, it was mainly labourers who were covered. This was followed by accident, pension and unemployment insurance.

Long-term care insurance was added in 1995. This is how the division between statutory and private health insurance came about in Germany.

FAQ

How does the free choice of doctor work in Germany?

In Germany, insured persons are free to choose their doctor, dentist or psychotherapist. They decide for themselves where they want to go. Doctors must treat every insured person.

Who can I turn to in the event of illness or health problems?

The family doctor or paediatrician is often the first port of call. If necessary, patients can be referred to specialists such as gynaecologists or dermatologists. At night or in emergencies, the medical on-call service on 116 117 or the emergency services on 112 can help.

What role do non-medical healthcare professionals play in healthcare?

Physiotherapists, speech therapists, nurses and midwives are important helpers in the healthcare system. They often need a prescription from a doctor for their treatments.

How does healthcare differ for those with statutory and private insurance?

People with statutory health insurance show their insurance card at the doctor's surgery. They have to make co-payments for some services. Privately insured people first pay themselves and then receive payment from their insurance company.

Since when has the German healthcare system existed in its current form?

The foundations of the system were laid at the end of the 19th century. Health insurance started in 1883. This was followed by accident, pension, unemployment and, in 1995, long-term care insurance.