How does the German Health Care System work?


Germany has a reputation for having one of the best and most comprehensive health care systems in the world, providing its residents with health, sick pay and long-term nursing care insurance coverage.The system takes care of around 83 million people .

The German health care system, established in the late 19th century, is historically the first universal health care system. Although the German health care system is among the systems providing a very high quality of health care, it is also one of the most expensive and keeps undergoing reforms to reduce costs and maintain or improve quality. The healthcare system is built on the idea of solidarity, ensuring equal access to medical services and insurance for everyone. Citizens and employers pay into the system, therefore, receiving free or heavily subsidized medical services. The system accounts for even those who are under unemployment benefits. This well-coordinated system functions like a sophisticated machine, with essential components working together to deliver comprehensive healthcare services to the population.

Here are some key features of the German healthcare system:

  1. Universal Coverage: The system provides healthcare coverage to all legal residents in Germany, regardless of their income or employment status.
  2. Health Insurance: The majority of individuals in Germany are covered by statutory health insurance (gesetzliche Krankenversicherung or GKV), which is funded through contributions from both employers and employees. Private health insurance (private Krankenversicherung or PKV) is available for higher-income earners and certain groups, such as self-employed individuals.
  3. Access to Care: The German system ensures access to a wide range of medical services, including preventive care, hospital treatment, specialist care, and prescription medications. There is a strong emphasis on primary care, with individuals typically required to consult a general practitioner as the first point of contact.
  4. Choice of Doctors: Patients have the freedom to choose their healthcare providers, including doctors, hospitals, and specialists, within the public or private system.
  5. Quality and Efficiency: Germany has a reputation for high-quality healthcare services and well-trained healthcare professionals. The system also places an emphasis on efficiency and cost-control measures.
  6. Long-Term Care: The German system also covers long-term care services, ensuring access to nursing care, rehabilitation, and assistance with daily activities for those in need.
  7. Financing: The healthcare system in Germany is financed through a combination of payroll contributions, government subsidies, and out-of-pocket payments. The contribution rates for statutory health insurance are income-based, with employers and employees sharing the costs.

Below are brief explanations of selected topics of the german health care system

How statutory health insurance works:

You pay a certain contribution to your health insurance provider every month. The health insurance then pays, for example, for; your treatment with a doctor; your treatment in hospital; any necessary medication. You get the treatment you need. It doesn’t matter how often you need treatment and you always pay the same contribution.

Your contributions to the statutory health insurance provider are based on your monthly income. If you have a job, the contribution is deducted directly from your
salary. Your employer pays you half of the contribution. If you are unemployed, the state pays your health insurance contributions.

Long-term care insurance

In Germany, everyone must have long-term care insurance. The contributions for long-term care insurance are paid together with the health insurance contributions.
Long-term care insurance pays for care and help in everyday life. Assistance is divided into 5 degrees of need for care. The more help you need, the higher the care level. The classification is made by the Medical Service. When you need care, there are three options:

  • relatives or neighbours take over responsibility for care at home
  • a care service takes over responsibility for care at home
  • a person has to move into a nursing home.

Long-term care insurance, for example, pays:

Care allowance:
You receive care allowance if you are cared for at home by relatives or neighbours.

Care benefit-in-kind:
Care benefits-in-kind are paid if you are cared for at home by a care service.

Other services for care at home:
This includes forms of assistance and technical aids.
Technical aids include, for example: care beds, toilet chairs, walking aids, rollators. Aids include, for example: Disposable gloves, Materials for disinfecting

Full inpatient benefits:
Full inpatient benefits are paid when you are cared for in a nursing home

Care consultation
People in need of care and any relatives who provide care can get advice on the benefits of long-term care insurance. The consultation is free of charge. The advisors will also come to you.You can get more information from
– the long-term care insurance funds and health insurance funds
– the care support centres.

Like Germany, almost all European countries are facing a major challenge: an aging population that requires more medical care, while at the same time there is a shortage of skilled workers and rising costs due to medical advances. The reform process of the health care system in Germany is still going on, actually a big hospital reform.

Written by Meltem Baskaya