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National markets insights: Germany




Healthcare System & Market


Germany is in central Europe, with 81.8 million inhabitants (December 2011), making it by some distance the most populated country in the European Union (EU). Berlin is the country’s capital and, with 3.5 million residents, Germany’s largest city.

In 2012 Germany’s gross domestic product (GDP) amounted to approximately €32 554 per capita (one of the highest in Europe). Germany is a federal parliamentary republic consisting of 16 states (Länder), each of which has a constitution reflecting the federal, democratic and social principles embodied in the national constitution known as the Basic Law (Grundgesetz).

By 2010, life expectancy at birth in Germany had reached 78.1 years for men and 83.1 years for women (slightly below the Eurozone average of 78.3 years for men and 84.0 years for women, although the gap with other similar European countries has been narrowing).

A fundamental facet of the German political system – and the health care system in particular – is the sharing of decision-making powers between the Länder, the federal government and civil society organizations. In healthcare, the federal and Länder governments traditionally delegate powers to membership-based (with mandatory participation), self-regulated organizations of payers and providers, known as “corporatist bodies”. In the statutory health insurance (Gesetzliche Krankenversicherung (SHI)) system, these are, in particular, sickness funds and their associations together with associations of physicians accredited to treat patients covered by SHI. These corporatist bodies constitute the self-regulated structures that operate the financing and delivery of benefits covered by SHI, with the Federal Joint Committee (Gemeinsamer Bundesausschuss) being the most important decision-making body. The Social Code Book (Sozialgesetzbuch (SGB)) provides regulatory frameworks; SGB V has details decided for SHI.

Since 2009, health insurance has been mandatory for all citizens and permanent residents, either through SHI or private health insurance (PHI). SHI covers 85% of the population – either mandatorily or voluntarily. Cover through PHI is mandatory for certain professional groups (e.g. civil servants), while for others it can be an alternative to SHI under certain conditions (e.g. the self-employed and employees above a certain income threshold). In 2012, the percentage of the population having cover through such PHI was 11%. PHI can also provide complementary cover for people with SHI, such as for dental care. Additionally, 4% of the population is covered by sector-specific governmental schemes (e.g. for the military). People covered by SHI have free choice of sickness funds, and are all entitled to a comprehensive range of benefits.

Germany invests a substantial amount of its resources in health care, €300.437 billion in 2012, e.g. 11.4% of GDP (one of the highest in the EU). Altogether, public sources accounted for 72.9% of total expenditure on health, with the rest of public funding coming principally from statutory long-term care insurance (Soziale Pflegeversicherung). Private sources accounted for 27.1% of total expenditure.

In 2012, there were 2017 hospitals with a total of 501 475 beds (6.2 beds per1000; higher than any other EU country). Of these, 48% of beds were in publicly owned hospitals, 34% in private non-profit and 18% in private for-profit hospitals.




Download the WHO Germany healthcare review

Download the CIVITAS German market report

Download the 2015 report on healthy living german market

Article eHealth legislation in Germany - 2015

German eHealth card (government)

German Ministry of Health website


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