The German healthcare system
The German healthcare system is neither homogenous nor static. On the contrary, it has various actors (i.e., medical and administrative staff, health insurers, the Federal Ministry of Health, regulatory bodies, etc.) and continuously progresses with the country's needs and technological advancements. In practice, the German healthcare system is divided into three sections: outpatient care, inpatient (hospital) care, and rehabilitation, which may take place in different facilities.
German healthcare system stakeholders
The Federal Ministry of Health (Bundesministerium für Gesundheit) is responsible for policy-making at the federal level. Besides developing laws, the Ministry of Health gives guidelines to self-governing bodies, such as the Federal Joint Committee (Gemeinsamer Bundesausschuss), the highest entity of self-governance. In addition, the Ministry of Health governs institutions and agencies dealing with public health, such as the Federal Institute for Drugs and Medical Devices (Bundesinstitut für Arzneimittel und Medizinprodukte) and the Paul Ehrlich Institute (PEI), responsible for approving vaccines. Last, for public health risks, such as COVID-19, hygiene in communal buildings, and protection against infections, the Public Health Service (Öffentlicher Gesundheitsdienst) is the body in charge.
Good to know:
Hospitals in Germany are run by cities and municipalities, church or religious groups, non-profit organizations (e.g., the Red Cross), and private sponsors. However, their operations are supervised by the German Hospital Federation (Deutsche Krankenhausgesellschaft).
Compulsory health insurance in Germany
Germany is known for having one of the world's most efficient and high-quality healthcare systems in the world. Waiting times to consult specialists or undergo surgery are rarely lengthy, healthcare costs, however, are relatively high, and coverage by public funds is only partial. Thus, it's logical that health insurance in Germany is mandatory, meaning that every citizen has to be covered by either state (Gesetzliche Krankenversicherung), financed by tax revenue surpluses and employees', as well as employers' monthly contributions, or private health insurance, depending on their preference and earnings. The National Association of Statutory Health Insurance Funds (GKV-Spitzenverband) is the federal-level association focusing on the healthcare of all 70 million statutory insured in Germany. On the other hand, private health insurers are represented by the Association of Private Insurers (PKV-Verband).
Good to know:
The German healthcare system is very much based on solidarity. In other words, the wealthy ensure that the less privileged also have access to quality healthcare by contributing higher premium levels towards the healthcare system, determined by their income. Here, it's worth noting that there's a maximum premium, which is calculated based on a certain income level, and it cannot be increased even if your earnings exceed the fixed mark.
Health insurance for expats in Germany
When you start working in Germany, you will have to choose a health insurance provider and inform your employer. Based on your needs and situation, you will have to choose between public and private insurance. If your annual gross income is below 64,350 Euros per year, you will need to register with one of the public health funds (Gesetzliche Krankenkasse). If your income is more than 64,350 Euros per year, you can remain insured with the public scheme; however, you will have to pay the mandatory premium to offer support to the system and the less privileged in it. You can choose your own public health fund from a wide range of approved providers, and the contribution will be deducted from your monthly salary. Even though all statutory health insurance companies provide a specified minimum performance, individual health insurance companies differ in their additional benefits. In general, people with a higher income level often opt for private coverage because it allows them to adjust their coverage and monthly contributions based on their healthcare needs (e.g., a young person who does not suffer from chronic diseases, etc.).
Important:
Public health funds do not provide optimal protection for certain types of specialized care (e.g., eye and dental care). In that case, you can opt for supplementary private health insurance to get full coverage.
Usually, the employee and the employer share precisely 50% of the social security contributions, which include:
- Care insurance (2.55%)
- Pension insurance (18.7%)
- Unemployment insurance (3%)
- Statutory health insurance (14.6% of the employee's gross monthly income)
However, it is often the case that the employee still pays an additional contribution. This can vary between 0.8% and 1.3%, depending on individual health insurance plans and income. Every person earning in Germany has to pay for health insurance. Specific groups also have to contribute, like those who receive unemployment benefits, artists and publicists, disabled people, students, and pensioners. Additionally, there are specific rules for children, spouses, and registered partnerships.
Attention:
If you are traveling to Germany as a non-EU citizen, you need to take out private health insurance before departure. Optimal coverage is essential due to expensive healthcare costs that might arise from an accident or severe illness during your stay in Germany.
There are many private health insurance companies to choose from in Germany, depending on your needs and budget. Some of the leading health insurance providers are:
- Allianz Care
- April MTC (My Travel Cover) - for less than 12 months cover
- April MHI (My Health International) - for more than 12 months cover
- Cigna Global
Get a free quote on Expat.com's health insurance for expatriates in Germany page.
Also, you may look at AOK health insurance, Techniker Krankenkasse, Germany's largest statutory health insurance fund, and Barmer.
Outpatient healthcare in Germany
In Germany, outpatient care (ambulante versorgung) is mainly provided by self-employed doctors, dentists, psychotherapists and other healthcare professionals in their private practices or medical centers (Praxiskliniken), where more than one specialists work, offering diagnostic examinations and outpatient, same-day surgeries. As long as the doctor or dentist has a statutory health insurance accreditation (Kassenzulassung), they can treat patients with public health insurance. Even though not necessary, patients usually consult their family doctor (Hausarzt) first for guidance and referral to a specialist (i.e., dermatologist, gynecologist, etc.). If you go into a hospital's emergency room for treatment, you may be offered outpatient care, meaning that you won't be kept through the night for treatment.
Good to know:
Family doctors in Germany can be GPs, internists, or pediatricians. When you fall ill, your first point of contact is usually your family doctor. However, you are free to choose from and see any doctor approved by the Statutory Health Insurance funds.
Inpatient healthcare in Germany
Suppose you have to spend the night in the hospital. In that case, you automatically become an inpatient, meaning that you will be charged additionally for the bed, meals, and other inpatient services, which are not covered by the state insurance. However, these extra costs shouldn't be kept secret, and patients or their next of kin are made aware of them in advance of the treatment. Rehabilitation treatments such as physiotherapy and psychological care can also be part of inpatient care, as their purpose is to support patients regain independence and physical strength after a severe illness or recovery from lengthy intensive care.
Preventive healthcare in Germany
Overall, the German healthcare system encourages the prevention of illnesses. For example, complying with annual dentist checkups (and proving this by collecting stamps) may result in lower dental expenses later. Also, some statutory and private insurers cover a certain amount of preventative courses, such as yoga or fitness classes, every year to motivate citizens to lead healthy lives. In addition, the Prevention Act (Präventionsgesetz) offers healthcare consultations to small and medium-sized enterprises and health checks and screening programs for children, young people, and adults. It also prioritizes individual burdens and risk factors for the development of diseases such as smoking, lack of exercise, diet, etc., aiming to help preserve and improve the health of German citizens.
Are you not feeling well and need assistance?
If you are suffering from a non-life-threatening emergency and your GP's practice is not open, you can call 116 117 for advice about what to do until you consult your family doctor. The service operates 24 hours, 7 days a week, thanks to a team of experienced on-call general practitioners and specialists who offer immediate advice or help you make an appointment with a specialist. Note that this number does not provide advice regarding dental care issues.
Attention:
For a life-threatening emergency, call 112.
Useful links:
Statutory health insurance dentists
European Health Insurance Card
EU citizens are covered in Germany by their European Health Insurance Card (EHIC), which can be helpful during the initial relocation period if you are still insured in your home country. With the EHIC, health-related costs in the country will be taken into charge in the same conditions as for German nationals. If you don't have an EHIC, visit your national health fund to get some information before traveling to Germany. The card is valid only for state-provided services and necessary services. However, it is not a substitute for travel insurance. The responsibility for issuing the EHIC does not lie with a person's state of residence but with the state where a person is paying to or benefiting from the Social Security System, so if you receive your pension and social security in Germany, you would have to register for German healthcare insurance.
Important:
When moving your habitual residence to Germany, you should register with the S1 form rather than using the EHIC. You can contact your local health insurance authority to locate the relevant institution issuing the S1. Once in possession of the S1, you must submit the form to the local German authority.
Attention:
EHIC does not cover costs if the purpose of your stay is obtaining medical treatment.
Useful links:
Gesetzliche Krankenkassen - Public health fund
European Health Insurance Card
COVID-19 in Germany
The Ministry of Health has launched the Together Against Coronavirus (Zusammen gegen Corona) initiative, supporting citizens to find reliable answers and trustworthy information about the pandemic and protection practices. In addition, you will find information about the vaccine, testing, and how to support your community during those unprecedented times. Some of the government's most effective measures during the peaks of the pandemic were a regulation requiring all hospitals nationwide to report their free beds in intensive care and postpone elective surgeries, which did not require urgent action. Also, the government compensated healthcare providers (e.g., doctors and nurses) with bonus financial support to show its gratitude for their work during the COVID-19 pandemic.
Useful links:
Summing up
In Germany, health insurance coverage is mandatory, and it can be either statutory (public health insurance) or private. Public health insurance contributions depend on one's income, irrespective of age and pre-existing health conditions. In addition, children and spouses of insured citizens are also covered free of charge. There isn't one public health insurance, meaning that citizens can do market research and choose the one that best suits their and their family's needs.
The German healthcare system doesn't prescribe medical treatments uncontrollably, meaning that fewer people take opioids, for example, or antibiotics. Some of the most commonly prescribed drugs are simple painkillers and anti-inflammatories, such as paracetamol and ibuprofen. Dental care in Germany is among the most expensive healthcare services. Thus, before undertaking any dental treatment, you should consult with your insurance to become aware of the coverage they will offer, which usually excludes materials such as porcelain and gold.
