Germany: health system review
AbstractThis publication reviews recent developments in organization and governance, health financing, health care provision, health reforms and health system performance. In the German health system, decision-making powers are traditionally shared between national (federal) and state (Land) levels, with much power delegated to self-governing bodies. It provides universal coverage for a wide range of benefits. Since 2009, health insurance has been mandatory for all citizens and permanent residents, through either statutory or private health insurance. A total of 70 million people or 85% of the population were covered by statutory health insurance in one of 132 sickness funds in early 2014. Another 11% were covered by substitutive private health insurance. Characteristics of the system are free choice of providers and unrestricted access to all care levels. A key feature of the health care delivery system is the clear institutional separation between public health services, ambulatory care and hospital (inpatient) care. This has increasingly been perceived as a barrier to change and so provisions for integrated care are being introduced with the aim of improving cooperation between ambulatory physicians and hospitals. Germany invests a substantial amount of its resources in health care: 11.4% of gross domestic product in 2012, which is one of the highest levels in the European Union. In international terms, the German health system has a generous benefit basket, one of the highest levels of capacity as well as relatively low cost-sharing. However, it still needs improvement in some areas, such as the quality of care. In addition, the division into statutory and private health insurance remains one of the largest challenges as it leads to inequalities.
World Health Organization. Regional Office for Europe, European Observatory on Health Systems and Policies, Busse, Reinhard & Blümel, Miriam. (2014). Germany: health system review. World Health Organization. Regional Office for Europe. https://apps.who.int/iris/handle/10665/130246
Health Systems in Transition, vol. 16 (2)