Overview

Germany has a complex and decentralized health system, with governance divided between the federal and state levels, and corporatist bodies of self-governance. Health insurance is compulsory and provided either under the statutory health insurance (SHI) scheme or through substitutive private health insurance (PHI). SHI covers a broad benefits basket, well beyond essential services, and benefits are the same for all those insured. Individuals covered by substitutive PHI usually enjoy benefits equal to or better than those covered by SHI. In 2019, health expenditure represented 11.7% of GDP, and per capita spending placed Germany among the top five spenders on health across EU countries and within the WHO European Region. There is a relatively low degree of cost sharing, with 12.7% of health spending coming from household out-of-pocket payments in 2019.

Over the last decade the health system has been characterized by stability and adherence to the basic structures and principles of SHI. In most cases, legislation has focused on incremental changes and implementation measures within individual sectors rather than landmark reforms. Policy developments have concentrated on ensuring equal access to ambulatory care, quality assurance in inpatient care, and strengthening coordination of care. Digitalization of the health system has been a major undertaking. At the core of this drive is the implementation of the electronic health card and a secure data exchange network among providers.