The German Healthcare System is one of the best in the world

THE GERMAN HEALTHCARE SYSTEM IS PROBABLY ONE OF THE BEST WORLDWIDE.

Since health insurance is obligatory, almost everyone is insured. On top of that, a very comprehensive coverage is available at relatively low rates.

And while you have to arrange insurance yourself, the German Healthcare System is very good at reminding you to do it. Key fact to remember: you need to have health insurance the moment you start working as an employee. Your employer will ask you for the details well before you start (your employer can't do the final payroll accounting if he has not registered you with an insurance company).

If you are unemployed, you are either covered by the insurance of your spouse or, the coverage is paid for out of the social funds automatically. Only very, very few citizens fall through this social web, freelancers for example who simply forgot to make arrangements.

Public Healthcare costs the almost the same at every insurance company, and the monthly fee is dependent on the level of salary. But independent of the monthly fee everybody gets the same coverage.

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 main idea of the statutory health system is the principle of solidarity. Membership in statutory health insurance is compulsory. The contributions are based on income to ensure that the cost of healthcare is shouldered primarily by the better-off, and everybody is able to access services. However, employees with an income above a certain threshold and the self-employed can opt out of the statutory system and insure themselves privately.

Five structural principles characterize the German social health insurance (SHI):

Solidarity
Benefits in kind: Beneficiaries receive immediate treatment, they do not have to pay upfront
Financing from employers and employees
Self-Administration
Plurality: Patients can choose amongst hospitals and private providers

It kind of works like a fund where members have to pay according to their ability.

The SHI is called in German "Gesetzliche Krankenversicherung" (GKV) and occupies a central position in the healthcare system in Germany. About 90 % of the population is covered by statutory health insurance. Private healthcare can either provide a complete health service for those who opt out of the SHI, or top-up cover for those who remain within it.

Before the most recent reform in 2011, SHI contributions were split almost equally between employers and employees. In light of rising health care expenditures, and thus rising non-wage labor costs, the reform froze the employers’ share of SHI contributions. There is now a difference of around 0.9 %. The employer pays 7.3 % and the employee 8.2 % of pre-tax income into SHI. All future cost increases will have to be borne by the insured.

Current ongoing discussions are about ...

eHealth
universal SHI (encompassing all citizens) and health premium (standard premium per head, subsidies based on income)
prioritization of special medical services
the role of the European Union in healthcare regulation
competition between statutory and private health insurance
introducing innovative care and stronger competition

About 350.000 physicians are practicing in Germany resulting in a proportion of around 3.4 per 1,000 inhabitants. The ratio, however, differs significantly between countryside and urban centers.

A physician running a practice needs to register with the Statutory Health Insurance Physicians (SHI - Kassenärztliche Vereinigung) unless he decides to take on private patients only. This institution has developed an enormous catalog of all possible medical services and assigned a value for each. Based on this catalog the physician invoices to the SHI directly. This also allows to analyze big data and recalculate the values per services. The physician can and will always try to attract private patients, too, because a similar catalog has been developed for private services - basically the same, but with higher value.

The education to become a doctor in Germany is still one of the hardest. Because of the high-income prospects, it was also the first choice for young students until recently. The possible income was significantly cut down by recent reforms, however, the profession of a doctor, especially if you had an own practice or were able to nail a Chefarzt position in a renowned hospital, is still one of the best-paying in Germany.

Prerequisites to become a doctor in Germany

6 years at a university, including the so-called practical year
emergency aid knowledge
work as a medical caretaker for 3 months
complete a clinical traineeship of 4 months
graduate in 3 state exams

In Germany, it is a custom that you choose a so-called "home doctor" (Hausarzt) - a general practitioner whom you'd be contacting first whenever you feel ill. If he believes you need to be looked at by a specialist, he will fill a so-called transversal note (Überweisung). Some practitioners have very good connections to various specialized doctors, and it is, in fact, time-saving to consult your home doctor first because that may decrease the waiting time at the specialist. Others don't. If you know you'd need a certain specialized doctor once in a while, it is wise to go there directly (i.e. gynecologist, urologist, oculist or the like). The two other doctors you would choose independently would be the dentist and, if applicable, the pediatrician.

Finding a good doctor is not so difficult. Apart from the fact that it is really a very personal perception of which criteria are essential for you, the medical university studies are of a very high quality in Germany, and you can usually trust any doctor.

Like with any serious issue it is sometimes recommended to get a second opinion, but other than that, doctors can be trusted.

Doctors usually speak some decent English so that they can make themselves comprehensible to you. It is, however, worthwhile to give their practice a call and verify. With the practice personnel, it is often difficult to communicate because their English may lack. If you don't get anywhere talking to them, don't give up but simply write them an email.

There are a couple of good websites which list doctors in the neighborhood and partly offer a rating. Google itself often already has some references based on Quipe.

www.jameda.de (with ratings)
www.quipe.com (with references)
www.docinsider.de (with references)
www.endconsumer.org (available in English, although references are usually in German)
www.www.aerztekammer-hamburg.de (official list of all doctors in Hamburg)

Hospitals in Germany are grouped into three main types:

Public hospitals (Öffentliche Krankenhäuser) are run by local state authorities, towns and the states
Voluntary, non-profit making hospitals (Freie gemeinnützige Krankenhäuser) run by churches or non-profit organizations, such as the German Red Cross
Private hospitals (Privatkrankenhäuser) run as free commercial enterprises

All of them have a very good reputation and are considered being amongst the world's best hospitals. They are modern and use the latest technology and provide high-quality medical care. See here to find a ranking of German hospitals.

Most hospitals cover a range of treatments, but not all. Once you have chosen your new home address, you may spend some time to review the scope of treatment offered by the two closest hospitals. If you need special treatment, your physician will recommend a hospital, but you are not bound to follow it. You may check here for the hospitals offering your demanded treatment.

While English-speaking nurses are rare, most doctors do speak good English.

If you are regularly insured in Germany the cost of hospital treatment in public hospitals (on referral by a doctor, or in emergencies) is covered by the public health authorities, except for a small daily charge from the start of hospital treatment up to a maximum of 14 days.

Private insurance is recommended for specialist medical treatment outside the German National Health Service, which can be expensive.

In case you are not regularly insured in Germany but are an EU citizen, the current rules for the coordination of social security-systems in Europa stipulate, that the German physician or hospital bills the treatment-costs for emergency cases to the respective foreign health insurance of the treated patient.

Patients are usually put into 3-bedrooms with no separation between the beds. You may buy additional private insurance to cover for a single room, but that may still not always be granted if the hospital has problems with its bed capacity at that specific point in time. Usually, it is possible. You can also book a "family room" in case you need to accompany your child, or your wife giving birth. Again, this depends on the availability of beds.

Every morning, doctors will do their visits and decide whether you are ready to go home or stay a day longer. Usually, you won't be released on a Sunday.

You will be given hospital gowns in case you have an operation and need to be treated with infusion or the like. Once you feel better, you may ask the nurses, whether you can put on your own clothes. The check-ups sometimes require your undressing, and it is expected that you just do as told. There will be no cover for parts of the body that don't need inspection, however, usually, your stripping down is limited to those that need examination. The hospital gowns are open on the back, and it can be very embarrassing to ie., use the toilet and be spotted by your co-patient. So bring a gown or pyjama and have it put in easy reach. Also to bring: towels, slippers, soap, toilet articles, and a washcloth.

Meals and mealtimes at hospitals conform to what's usual in Germany: breakfast and dinner will be bread, lunch some hot meal. You can often choose out of two options. And in some cases, there may be patient fridges, and you can bring your own food and put it there (if labeled).

If your annual gross income is below the threshold of €66.600 ("Jahresarbeitsentgeltgrenze" - as per 2023), you will need to register with one of the public health funds ("Pflichtmitgliedschaft"), unless you had been insured privately in Germany sometime in the past. Decisive is what you earn as an individual, the family income is not relevant. You can choose your own public health fund among a wide range of approved providers. The contribution will be deducted from your monthly salary. For some special care (eye and dental care), public health funds do not provide optimal protection. You can then take out supplementary private health insurance to get full coverage.

Public Health Care insurance companies offer the same scope of coverage to a degree of 98%. The remaining services are used to distinguish one company over the other. Their scope of services generally cover all medical treatments your doctors decide you need to have. Some limits are individually regulated via the service catalog and regularly comprise treatments which contain an additional benefit to you (i.e. ceramic dental filling), and you'll have to pay on your own if you wanted those treatments. Usually, these payments are affordable. Mostly, these will occur with dental treatment.

They do not pay for treatments which are not yet proven to be helpful. Especially for rare illnesses, this may cause problems. But then private healthcare insurers pay a little more but neither do they pay for treatments with unproven efficiency.

Medical and dental treatment, with free choice of doctor or dentist
hospital treatment
Medicines, bandages, corresponding treatments, and tools such as hearing aids and wheelchairs
Sickness allowance: your employer pays your salary for up to 6 weeks sickness induced absence. After that, the health insurance pays 70% of your salary for up to 78 weeks
Preventive Check-Ups
Vaccinations, except for vaccinations for foreign travel
Orthodontic treatments, usually up to the age of 18 years
Medically necessary dental fillings and crowns

Generally speaking, public health insurance cost you between 14,6% plus 2,55 % (plus 0,25% for childless members - the so-called "Pflegepflichtversicherung" or longterm care insurance) of your gross salary. Most insurers set their premiums to 15,60%. Your employer will pay 50% of the premium, i.e. 7,3% of your gross salary. The maximum monthly fee is the above share on 59.850 EUR (the so-called "Beitragsbemessungsgrenze").

However, the insurers can now determine a small portion of the amount of the monthly premiums themselves. They are allowed to charge additional premiums for additional services - and many do so. The range of premiums is currently between 14.6 to 15.9 percent (the employer does NOT contribute to the exceeding part of the premium, his share remains at 7,3%). These can be special services around vaccination, pregnancy, special healing methods, dental care or financial bonus programs.

You can always cancel your membership with a public insurer at any time. The notice period is 2 months to the end of the month. After having changed to a new insurer, you are bound to this choice for at least 18 months.
If your current health insurance demands an additional premium, you have an extraordinary cancellation right that is valid for 2 months after the new premium became effective.
If you have contracted an additional service, i.e. a special tariff, you are bound to it for 3 years.

And if you want to change over to private healthcare, the cancellation period is 2 months and the 18 months period from above does not apply.

One of the most critical differences to private healthcare is the possibility to insure direct family members for free. This can make the financial advantage of the private healthcare obsolete. The family insurance covers spouses and children with no own income. They will always fall under the insurance of the spouse who has the higher income.

Prerequisites:

both, husband and spouse, need to be insured with public healthcare.
the spouse does not earn more than 4.575 EUR a month (as of 2022)
the spouse is not self-employed, respectively the average monthly income does not exceed 485 EUR
the spouse is not insured with a different public health insurance

The latter is more theoretical as your spouse would cancel his/her membership with that other insurer and become a member of yours.

If your gross annual income is above €64.350 (as per 2022), or if you are self-employed or unemployed, you may opt for a private health fund. The freedom of choice for a private (or public) health insurer is limited also by your historical contracts. If you've been a member of a private insurance fund before and you earn less than the said €64.350, you have no choice but to stay private.

Like public insurance companies, private insurance companies are obliged to contract with any person applying for coverage. To deal with this relatively new requirement all private healthcare insurers have come up with a "Basistarif" offering similar benefits to the government system.

In other words, if you have a serious pre-existing medical condition and won't be accepted into regular private health insurance tariffs, you can purchase this tariff as a last resort.

Benefits are almost similar to that of the public system with a more comprehensive coverage of dental and eye care. Note that with a private health fund, you can adjust your level of coverage and your monthly contributions based on your own healthcare needs (if you are young, if you do not suffer from chronic diseases, etc.). A true advantage is the significantly shorter wait time for non-urgent doctor appointments. since doctors can also charge more for the same treatment, they usually welcome you as new patient and you will not struggle finding a doctor.

The "Basistarif", which means the minimum services tariff, equals the services of a public insurance company in scope and pricing. The belief that private healthcare may be too expensive in old age is not true. You are always free to downgrade to the Basistarif.

The premiums vary significantly and are based on your medical condition and personal risk profile as well as your own choice of services. Private health insurance, at first sight, seems to be much cheaper, however, in a family situation every family member has to be individually insured, while in public insurances the one covering the breadwinner automatically covers all remaining family members.

If you are employed, your employer will pay 50% of the premium, but maximum the same amount as if you were a member of a public insurance fund, i.e. 7,3% of your gross monthly salary with the limits to be considered (see Public Healthcare Insurance above).

The premiums can be reduced by accepting a deductible.

In contrast to public healthcare premiums, the premiums for private healthcare are not limited. If medical cost increase, the private insurers are entitled to increase your premiums. And indeed, although no statistics are available, the premiums for the same service were increased more than in the public insurance.

Depending on the start of the insurance private health insurance can be canceled at the end of the calendar year or the insurance year. The cancellation period is three months ahead. Often, however, a minimum membership period between one and three years must be respected.

A cancellation will only take effect once a new insurance coverage can be demonstrated within the notice period.

If someone wishes to contract with public insurance, then the cancellation rules of the public insurers are valid (i.e. 2 months to month's end). This is only possible if the yearly income drops below the income limits for the public healthcare insurance, or if he registers as unemployed.

The member can also cancel in case of premium increases or changes in the scope of services. He must then do so within 2 months of the change.

THE GERMAN HEALTHCARE SYSTEM IS PROBABLY ONE OF THE BEST WORLDWIDE.

Since health insurance is obligatory, almost everyone is insured. On top of that, a very comprehensive coverage is available at relatively low rates.

THE BASICS

Origin & Players

Principles & Obligations

Subsidiarity

Self-Administration

Corporatism

Current Reforms and Discussions

PHYSICIANS & HOSPITALS

Physicians

Educational background of German doctors

How to find a good physician

Hospitals

Cost of Treatment

German specifics of hospital treatments

File Download for Hamburg

PUBLIC HEALTHCARE INSURANCE

Income limits

Scope of Services

Monthly premiums

Cancellation Periods

Family Insurance

The big players

Distinct offers for Expatriates

The Techniker Krankenkasse (TK)

Siemens Betriebskrankenkasse (SBK)

Barmer GEK

BKK

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PRIVATE HEALTHCARE

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Cancellation Periods

The big players

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