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Health Systems and Policy Monitor (HSPM)

An innovative platform that provides a detailed description of health systems and provides up-to-date information on reforms and changes that are particularly policy relevant.
For detailed information on country policy responses to the COVID-19 pandemic during 2020-2021, see our separate COVID-19 Health Systems Response Monitor (HSRM).

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Germany

Health Systems in Transition (HiT) profile

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  1. Country Overview

  2. Health Systems in Transition (HiT) profile

    1. 1. Introduction
      1. 1.0. Introduction
      2. 1.1. Geography and sociodemography
      3. 1.2. Economic context
      4. 1.3. Political context
      5. 1.4. Health status
    2. 2. Organization and governance

      Updated: 10 May 2024
      1. 2.0. Introduction
      2. 2.1. Historical background
      3. 2.2. Organization
      4. 2.3. Decentralization and centralization
      5. 2.4. Planning
      6. 2.5. Intersectorality
      7. 2.6. Health information systems

        Updated: 10 May 2024
      8. 2.7. Regulation
      9. 2.8. Person-centred care
    3. 3. Financing

      Updated: 28 March 2025
      1. 3.0. Introduction
      2. 3.1. Health expenditure
      3. 3.2. Sources of revenue and financial flows
      4. 3.3. Overview of the statutory financing system
      5. 3.4. Out of pocket payments
      6. 3.5. Voluntary (private) health insurance
      7. 3.6. Other financing
      8. 3.7. Payment mechanisms

        Updated: 28 March 2025
    4. 4. Physical and human resources

      Updated: 11 August 2025
      1. 4.0. Introduction
      2. 4.1. Physical resources

        Updated: 09 October 2023
      3. 4.2. Human resources

        Updated: 11 August 2025
    5. 5. Provision of services

      Updated: 08 August 2025
      1. 5.0. Introduction
      2. 5.1. Public health

        Updated: 08 August 2025
      3. 5.2. Patient pathways
      4. 5.3. Primary care

        Updated: 31 January 2025
      5. 5.4. Specialized care

        Updated: 03 August 2023
      6. 5.5. Urgent and emergency care

        Updated: 30 October 2024
      7. 5.6. Pharmaceutical care
      8. 5.7. Rehabilitation and intermediate care
      9. 5.8. Long term care

        Updated: 02 June 2023
      10. 5.9. Services for informal carers
      11. 5.10. Palliative care
      12. 5.11. Mental health care
      13. 5.12. Dental care
    6. 6. Principal health reforms

      Updated: 15 May 2022
      1. 6.0. Introduction
      2. 6.1. Analysis of recent reforms

        Updated: 15 May 2022
      3. 6.2. Future developments
    7. 7. Assessment of the health system

      Updated: 31 January 2025
      1. 7.0. Introduction
      2. 7.1. Health system governance
      3. 7.2. Accessibility
      4. 7.3. Financial protection

        Updated: 31 January 2025
      5. 7.4. Health care quality
      6. 7.5. Health system outcomes
      7. 7.6. Health system efficiency
    8. 8. Conclusions
      1. 8.0. Introduction

7.6. Health system efficiency

Germany spends a substantial amount of its wealth on health. Total expenditure on health amounted to 11.7% of GDP in 2018 according to data of the Federal Statistical Office. According to WHO data, per capita health expenditure more than doubled between 2000 and 2018, from USGDP in 2018 according to data of the Federal Statistical Office. According to WHO data, per capita health expenditure more than doubled between 2000 and 2018, from US$ 2687 (adjusted for differences in purchasing power) to US$ 6098, which ranks Germany third in comparison to other WHO Europe countries in 2018 (after Switzerland and Norway) (World Health Organization Regional Office for Europe, 2020) (see section 3.1 Health expenditure). By OECD data, health expenditure in Germany as a share of GDP was the fourth highest share among OECD countries (after the United States, Switzerland and Norway) and per capita spending was way above the OECD36 average of US$ 3994 in 2018 (OECD, 2019).

Per capita expenditure on health in Germany rose by an average of 2.5% per annum in real terms between 2013 and 2018 (up from 2.1% p.a. between 2008 and 2013). In comparison to other OECD countries, this was a relatively large increase during this period, and higher than in the Netherlands (0.5%), France (0.8%), Austria (1.0%), Switzerland (2.1%) and the OECD36 average (2.4%). According to OECD calculations, average per capita health expenditure growth is projected at 1.9% a year between 2015 and 2030, which would reflect a moderate increase compared to other OECD countries (OECD, 2019). The pace of health expenditure growth is partly attributable to the comparatively large human, technical and infrastructural resources in the German health care system and a high level of activity (e.g. in terms of consultations, hospital cases, consumption of pharmaceuticals). In addition, the full implementation of reforms to the LTCI scheme, such as the broadening of eligibility criteria and benefits, and a rapidly ageing population, represents additional pressures on the sustainability of financing (see section 5.8 Long-term care).

One attempt to provide a very cursory illustration of how the health system is performing in terms of input costs and outcomes is to plot current expenditure on health against the amenable mortality rate. Although we must be mindful that it is not possible to effectively disentangle the role of health behaviour and other determinants of the health care system in influencing the level of amenable mortality, Fig7.9 provides a useful entry point for discussion. Germany’s amenable mortality rate has been falling continuously, but it has remained higher than in neighbouring countries throughout the years 2011–2017; at the same time, the country recorded the second highest health expenditure level in 2017, after Switzerland (Fig7.9). The results suggest that the other countries have been able to secure better outcomes on this metric at lower cost (except for Switzerland, whose health expenditure far exceeds that of all the other countries).

Fig7.9

nbsp;2687 (adjusted for differences in purchasing power) to USGDP in 2018 according to data of the Federal Statistical Office. According to WHO data, per capita health expenditure more than doubled between 2000 and 2018, from US$ 2687 (adjusted for differences in purchasing power) to US$ 6098, which ranks Germany third in comparison to other WHO Europe countries in 2018 (after Switzerland and Norway) (World Health Organization Regional Office for Europe, 2020) (see section 3.1 Health expenditure). By OECD data, health expenditure in Germany as a share of GDP was the fourth highest share among OECD countries (after the United States, Switzerland and Norway) and per capita spending was way above the OECD36 average of US$ 3994 in 2018 (OECD, 2019).

Per capita expenditure on health in Germany rose by an average of 2.5% per annum in real terms between 2013 and 2018 (up from 2.1% p.a. between 2008 and 2013). In comparison to other OECD countries, this was a relatively large increase during this period, and higher than in the Netherlands (0.5%), France (0.8%), Austria (1.0%), Switzerland (2.1%) and the OECD36 average (2.4%). According to OECD calculations, average per capita health expenditure growth is projected at 1.9% a year between 2015 and 2030, which would reflect a moderate increase compared to other OECD countries (OECD, 2019). The pace of health expenditure growth is partly attributable to the comparatively large human, technical and infrastructural resources in the German health care system and a high level of activity (e.g. in terms of consultations, hospital cases, consumption of pharmaceuticals). In addition, the full implementation of reforms to the LTCI scheme, such as the broadening of eligibility criteria and benefits, and a rapidly ageing population, represents additional pressures on the sustainability of financing (see section 5.8 Long-term care).

One attempt to provide a very cursory illustration of how the health system is performing in terms of input costs and outcomes is to plot current expenditure on health against the amenable mortality rate. Although we must be mindful that it is not possible to effectively disentangle the role of health behaviour and other determinants of the health care system in influencing the level of amenable mortality, Fig7.9 provides a useful entry point for discussion. Germany’s amenable mortality rate has been falling continuously, but it has remained higher than in neighbouring countries throughout the years 2011–2017; at the same time, the country recorded the second highest health expenditure level in 2017, after Switzerland (Fig7.9). The results suggest that the other countries have been able to secure better outcomes on this metric at lower cost (except for Switzerland, whose health expenditure far exceeds that of all the other countries).

Fig7.9

nbsp;6098, which ranks Germany third in comparison to other WHO Europe countries in 2018 (after Switzerland and Norway) (World Health Organization Regional Office for Europe, 2020) (see section 3.1 Health expenditure). By OECD data, health expenditure in Germany as a share of GDP was the fourth highest share among OECD countries (after the United States, Switzerland and Norway) and per capita spending was way above the OECD36 average of USGDP in 2018 according to data of the Federal Statistical Office. According to WHO data, per capita health expenditure more than doubled between 2000 and 2018, from US$ 2687 (adjusted for differences in purchasing power) to US$ 6098, which ranks Germany third in comparison to other WHO Europe countries in 2018 (after Switzerland and Norway) (World Health Organization Regional Office for Europe, 2020) (see section 3.1 Health expenditure). By OECD data, health expenditure in Germany as a share of GDP was the fourth highest share among OECD countries (after the United States, Switzerland and Norway) and per capita spending was way above the OECD36 average of US$ 3994 in 2018 (OECD, 2019).

Per capita expenditure on health in Germany rose by an average of 2.5% per annum in real terms between 2013 and 2018 (up from 2.1% p.a. between 2008 and 2013). In comparison to other OECD countries, this was a relatively large increase during this period, and higher than in the Netherlands (0.5%), France (0.8%), Austria (1.0%), Switzerland (2.1%) and the OECD36 average (2.4%). According to OECD calculations, average per capita health expenditure growth is projected at 1.9% a year between 2015 and 2030, which would reflect a moderate increase compared to other OECD countries (OECD, 2019). The pace of health expenditure growth is partly attributable to the comparatively large human, technical and infrastructural resources in the German health care system and a high level of activity (e.g. in terms of consultations, hospital cases, consumption of pharmaceuticals). In addition, the full implementation of reforms to the LTCI scheme, such as the broadening of eligibility criteria and benefits, and a rapidly ageing population, represents additional pressures on the sustainability of financing (see section 5.8 Long-term care).

One attempt to provide a very cursory illustration of how the health system is performing in terms of input costs and outcomes is to plot current expenditure on health against the amenable mortality rate. Although we must be mindful that it is not possible to effectively disentangle the role of health behaviour and other determinants of the health care system in influencing the level of amenable mortality, Fig7.9 provides a useful entry point for discussion. Germany’s amenable mortality rate has been falling continuously, but it has remained higher than in neighbouring countries throughout the years 2011–2017; at the same time, the country recorded the second highest health expenditure level in 2017, after Switzerland (Fig7.9). The results suggest that the other countries have been able to secure better outcomes on this metric at lower cost (except for Switzerland, whose health expenditure far exceeds that of all the other countries).

Fig7.9

nbsp;3994 in 2018 (OECD, 2019).

Per capita expenditure on health in Germany rose by an average of 2.5% per annum in real terms between 2013 and 2018 (up from 2.1% p.a. between 2008 and 2013). In comparison to other OECD countries, this was a relatively large increase during this period, and higher than in the Netherlands (0.5%), France (0.8%), Austria (1.0%), Switzerland (2.1%) and the OECD36 average (2.4%). According to OECD calculations, average per capita health expenditure growth is projected at 1.9% a year between 2015 and 2030, which would reflect a moderate increase compared to other OECD countries (OECD, 2019). The pace of health expenditure growth is partly attributable to the comparatively large human, technical and infrastructural resources in the German health care system and a high level of activity (e.g. in terms of consultations, hospital cases, consumption of pharmaceuticals). In addition, the full implementation of reforms to the LTCI scheme, such as the broadening of eligibility criteria and benefits, and a rapidly ageing population, represents additional pressures on the sustainability of financing (see section 5.8 Long-term care).

One attempt to provide a very cursory illustration of how the health system is performing in terms of input costs and outcomes is to plot current expenditure on health against the amenable mortality rate. Although we must be mindful that it is not possible to effectively disentangle the role of health behaviour and other determinants of the health care system in influencing the level of amenable mortality, Fig7.9 provides a useful entry point for discussion. Germany’s amenable mortality rate has been falling continuously, but it has remained higher than in neighbouring countries throughout the years 2011–2017; at the same time, the country recorded the second highest health expenditure level in 2017, after Switzerland (Fig7.9). The results suggest that the other countries have been able to secure better outcomes on this metric at lower cost (except for Switzerland, whose health expenditure far exceeds that of all the other countries).

Fig7.9

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