German Healthcare System Explained

The German healthcare system is an old and well-established structure that has grown over hundreds of years. It offers near-universal coverage using a multi-payer model. At its center are two main pillars: statutory health insurance (GKV) and private health insurance (PKV). Together, they give almost all residents access to medical care. The system is not run directly by the central government; instead, many different bodies share responsibility, from federal ministries to regional provider associations. Its roots go back to medieval guilds and later to the 19th century and Bismarck’s social reforms. Built on the idea of solidarity, it is one of the oldest national health insurance systems in the world. It is known for good outcomes and strong access to care and is often discussed as a model by other countries.

How does the German healthcare system work?

To understand how German healthcare works, it helps to look at its main principles and the way they give broad access to the population. The system has been adjusted many times since the 19th century, strongly shaped by Otto von Bismarck’s social policy laws.

What principles guide the German healthcare system?

The system rests on four main principles: compulsory insurance, funding through insurance contributions, solidarity, and self-governance.

• Compulsory insurance: Everyone living in Germany must have health insurance. This rule has led to almost 100% coverage today, compared to only about 10% when health insurance first appeared in 1883. Health care is treated as a basic right, not just a benefit for some.
• Funding through contributions: Money mainly comes from regular payments (premiums) made by insured people and their employers. Taxes play a smaller role through subsidies, so the system largely finances itself.
• Self-governance: The government sets the laws, but the planning, organization, and financing of services are done by insurance funds and professional organizations inside the system.

What is the principle of solidarity in German healthcare?

Solidarity means “the rich help the poor, and the healthy help the sick.” All people with public health insurance and their employers pay monthly income-based premiums into a common pool. Those who earn more pay a higher share of their income, up to a defined maximum income level (Beitragsbemessungsgrenze). But everyone covered by GKV has the same right to the same services, no matter how much they personally pay. Some family members, such as spouses and children with low or no income, can be added to the public plan free of charge. In this way, strong earners support weaker ones, and healthy people help cover the costs of those who are ill.

How is access to healthcare guaranteed?

Access is mainly guaranteed through the rule that health insurance is mandatory for everyone. Since 2009, all citizens and permanent residents must be insured. Most people are in statutory health insurance (GKV). Higher earners above a certain income level, the self-employed, and civil servants may choose private health insurance (PKV) instead. Together, GKV and PKV form a dual system.

Public rules strictly limit out-of-pocket payments and define a broad standard benefits package through the Federal Joint Committee (G-BA). This keeps financial barriers low. People can usually choose their doctors freely and, in many cases, see specialists directly. As a result, the system is quite consumer-friendly.

Who is covered by the German healthcare system?

The German system aims to include almost everyone living in the country. This wide coverage comes from history and from the idea of solidarity that still guides policy today.

Which groups are included in statutory coverage?

Roughly 89% of the population has statutory health insurance (GKV). This group includes:

• Most employees with annual earnings below €73,800 (as of 2025). They are automatically enrolled in one of many non-profit sickness funds.
• People receiving social welfare, with contributions paid by municipalities.
• Retirees and people receiving unemployment benefits (Unemployment Benefit I and II), who remain insured through GKV.

GKV also offers Familienversicherung (family insurance). Spouses, registered partners, and children can be covered at no extra cost if income rules are met. Children are usually covered up to a certain age or longer if they are still in education and meet the conditions.

How are children, unemployed, and uninsured individuals protected?

Children: If both parents have GKV, children are included in the family insurance free of charge. If one parent has PKV and the other GKV, the child is usually insured with the GKV parent, unless the privately insured parent has a higher income above certain limits. In that case, the child may need private insurance. Medical treatment for children, including vaccinations, is free under GKV until the age of 18. Parents can go straight to a pediatrician without a referral, and children’s hospitals offer specialized services.

Unemployed people: Health insurance remains mandatory. Those receiving Unemployment Benefit I are automatically covered by GKV, with contributions paid by the Federal Employment Agency. Recipients of Unemployment Benefit II stay in GKV with contributions paid by the Jobcenter. People who are unemployed but do not receive these benefits need to arrange insurance on their own, either voluntary GKV or PKV at full cost.

A small number of people remain uninsured, often among the self-employed or those in unstable jobs. Professional and public bodies try to reduce these gaps so that the promise of universal coverage is upheld in practice.

How is healthcare in Germany funded?

German healthcare is paid for through a mix of public and private money. Responsibility is shared between insured people, employers, and the state, with competition between funds inside a tightly regulated framework.

How does statutory health insurance (GKV) work?

GKV is the main funding pillar and covers about 89% of residents. Contributions depend on income and are split between employees and employers. As of 2021, the basic contribution rate was 14.6% of gross salary up to an income cap (€64,350 at that time), with employee and employer each paying about 7.3%. Each sickness fund can also charge an extra contribution on top of this; on average this was around 1.3% in 2021.

All contributions flow into a central Health Fund (Gesundheitsfonds) and are then distributed to the individual sickness funds using a risk-based formula. The system works on a pay-as-you-go basis: the current working generation finances benefits for pensioners and others. Public sickness funds must accept anyone who qualifies and provide a standardized benefits package with a defined minimum level of care.

What is private health insurance (PKV)?

Private health insurance is open mainly to:

• Employees with income above the GKV threshold (€73,800 in 2025),
• Civil servants,
• Self-employed people.

Around 11% of people in Germany have PKV. Premiums are not based on current income but on risk factors such as age, health at the time of joining, and the chosen benefits. Private insurers must build up ageing reserves (Alterungsrückstellungen) to limit premium increases in old age.

PKV often includes wider benefits, such as more dental coverage, private hospital rooms, and sometimes shorter waiting times. But changing back from PKV to GKV is only possible in limited situations, usually if you are under 55 and your income falls below the threshold. Joining PKV is therefore a long-term decision.

What is supplementary insurance?

Supplementary insurance is extra coverage you can buy in addition to GKV or PKV. It is especially common in dental care, as statutory dental benefits are often limited. Popular add-ons include:

• Dental plans covering crowns, implants, and dentures,
• Hospital add-ons for a single room or choice of senior doctor,
• Daily sickness benefit insurance to replace income after long illness.

These policies usually have maximum reimbursement limits in the first years. Any costs above these limits or above the maximum fee levels in the tariff must be paid by the patient.

How do you access healthcare and insurance in Germany?

For newcomers, getting into the German system has two main steps: joining a health insurer and then learning how to use the card to get care.

What steps are required for health insurance registration?

Long-term residents and workers must first register their address at the local registration office (Einwohnermeldeamt). After this, you choose a health insurance fund. Employees below the income threshold usually join a statutory sickness fund.

Although about 95% of GKV benefits are the same across all funds, there are differences in extra services and the level of the additional contribution rate. These details are listed on the funds’ websites and on comparison portals.

Once registered, your insurer sends you an electronic health card (Gesundheitskarte) with your photo (for those 15 and older). The card stores basic personal and insurance data. You present it at every visit to the doctor, dentist, or hospital so they can bill your insurer.

Which organizations are responsible for insurance and care delivery?

The structure is decentralized, with many organizations working together:

• Sickness funds (Krankenkassen): Public health insurers that organize coverage and contracts with providers.
• GKV-Spitzenverband: The national association that represents all public insurers at the federal level.
• PKV-Verband: The association of private health insurers.
• Provider associations: Groups of doctors, dentists, hospitals, and pharmacies that negotiate contracts and fee schedules.

Outpatient care is mainly delivered by privately run practices. Inpatient care is provided by a mix of public, non-profit, and private hospitals. State-level doctors’ associations (kassenärztliche Vereinigungen) make sure there are enough practices and agree fees with the sickness funds.

What are the main institutions in the German healthcare system?

A large number of public bodies and professional groups set rules, monitor quality, and plan services. Together they keep the system running and develop it over time.

What is the role of the Federal Ministry of Health (BMG)?

The Federal Ministry of Health (Bundesministerium für Gesundheit, BMG) is the key national authority for health policy. It does not run hospitals or insurers directly but writes laws and regulations that frame all activities in the system.

The BMG is also responsible for several important specialist agencies, including:

• BfArM (Federal Institute for Drugs and Medical Devices): Decides on approvals and safety of medicines and medical devices.
• Paul Ehrlich Institute (PEI): Approves vaccines and some biomedicines.
• Robert Koch Institute (RKI): Germany’s central body for infectious disease control and public health monitoring.

Through these institutions, the BMG sets the general direction for health protection, pharmaceuticals, and long-term care insurance.

What does the Federal Joint Committee (G-BA) do?

The Federal Joint Committee (Gemeinsamer Bundesausschuss, G-BA) is the highest decision-making body for services covered by statutory health insurance. It brings together representatives of:

• Doctors and psychotherapists,
• Dentists,
• Hospitals,
• Public health insurers,
• Patient representatives (with advisory role, no vote).

The G-BA decides which treatments, medicines, and procedures GKV will pay for and under what conditions. It defines what is “sufficient, necessary, and economically reasonable” care and sets quality requirements for certain services.

Two independent scientific institutes support its work:

• IQWiG: Assesses benefits and harms of treatments and medicines.
• IQTIG: Monitors quality of care in practices and hospitals.

Their reports form the basis for many G-BA decisions.

How do providers and associations shape the system?

Professional associations have strong influence because they organize service delivery and take on regulatory tasks.

• Doctors and psychotherapists: All who work with GKV must join state kassenärztliche Vereinigungen (KV). At national level, they are represented by the Kassenärztliche Bundesvereinigung (KBV).
• Dentists: Organized in regional Kassenzahnärztliche Vereinigungen (KZV) and nationally by the Kassenzahnärztliche Bundesvereinigung (KZBV).
• Hospitals: Represented by the German Hospital Federation (Deutsche Krankenhausgesellschaft, DKG).
• Pharmacies: Local and regional chambers and associations sign contracts with the GKV-Spitzenverband and individual funds.

These bodies must make sure enough services are available, negotiate fees, and check the billing of practices. In addition, all doctors, dentists, pharmacists, and other regulated health professions must belong to their state professional chambers. These chambers oversee professional rules, training, exams, and handle complaints and malpractice cases.

What does the German healthcare system cover?

German health insurance offers a wide range of services, from basic preventive checks to hospital treatment and rehabilitation. Most common medical needs are covered.

What services are available through public health insurance?

GKV covers, among other things:

• Visits to general practitioners and specialists in outpatient practices,
• Hospital stays and emergency treatment,
• Prescribed medicines and vaccines (with small co-payments),
• Basic dental care, eye care, and some approved alternative treatments,
• Mental health care, including psychotherapy for a defined number of sessions,
• Sickness benefit (Krankengeld) after an initial period, paying about 70% of gross income when off work sick for longer than six weeks,
• Full coverage of maternity care, including antenatal checks, birth, and postnatal care.

The G-BA defines the catalog of services and reviews it regularly. All GKV funds must provide at least this basic package.

What types of care are included (outpatient, inpatient, rehabilitation)?

Care is usually grouped into three main forms: outpatient, inpatient, and rehabilitation.

Outpatient care (ambulante Versorgung) covers all treatments without an overnight stay. It mainly takes place in doctors’ and dentists’ practices and in psychotherapists’ offices. Most of these providers are allowed to treat GKV patients (Kassenzulassung). People often go first to their family doctor (Hausarzt), who may refer them to specialists. But in many cases, such as gynecology, patients can also go directly to a specialist.

Inpatient treatment (stationäre Behandlung) means staying at least one night in a hospital. Germany has public, non-profit, and private hospitals, and most treat both public and private patients. GKV patients pay a fixed daily fee for room and board up to a yearly limit. Hospitals deal with acute illness, surgery, and complex treatments.

Rehabilitation (Reha) helps people recover after serious illness or surgery and aims to avoid permanent disability or long-term care. Rehab can be done in specialized inpatient clinics (Rehakliniken) or on an outpatient basis. Programs may include physiotherapy, occupational therapy, psychological support, and nutritional advice. A doctor must certify the medical need, and costs are usually covered by health, pension, accident, or long-term care insurance, depending on the case. Adults often pay a small daily co-payment.

What types of healthcare services does Germany offer?

Germany offers many different health services so that people can get help ranging from simple check-ups to high-level specialist care and emergency treatment.

How does outpatient care in Germany function?

Outpatient care is the first stop for most health problems. It is delivered by:

• Single practices (solo doctors, dentists, psychotherapists),
• Group practices (Gemeinschaftspraxen),
• Medical care centers (Medizinische Versorgungszentren, MVZ).

People usually register with a family doctor (Hausarzt), who may be a general practitioner, internist, or pediatrician. The family doctor handles general health issues, preventive checks, and coordination with specialists. Most GKV patients can still visit many specialists without a referral, but for some, like radiologists, a referral is required. Some practices function almost like mini-clinics (Praxiskliniken), offering complex diagnostics or day surgery.

What is provided by German hospitals and inpatient care?

Hospitals (Krankenhäuser) provide care when an illness or procedure requires one or more nights in the facility. There are three main types:

• Public hospitals run by cities, districts, or states,
• Non-profit hospitals run by churches or charities,
• Private hospitals, some of which treat only privately insured patients.

Hospitals deliver emergency care, surgery, intensive care, and many specialized treatments. Planning and regulation of hospitals are done by the federal states, which leads to some regional differences. GKV patients usually pay around €10 per day for accommodation and meals, up to a yearly maximum. Average lengths of stay are shorter than in the past but still slightly longer than in some other high-income countries.

What are the options for mental health, women’s health, and children’s healthcare?

Mental health: Germany has expanded mental health services in recent years. Family doctors often make the first assessment, prescribe basic medication if appropriate, and refer to specialists. Patients can also directly contact psychiatrists, psychological psychotherapists, or specialized clinics. For more severe or chronic conditions, psychosomatic clinics and psychiatric hospitals offer day programs or inpatient treatment.

Women’s health: Gynecologists (Frauenärzte) are easy to reach and can usually be seen without a referral in GKV. They provide contraception, pregnancy care, cancer screening, and treatment of gynecological conditions. Midwives work closely with gynecologists to support pregnancy, birth, and the postnatal period. Statutory insurance pays for all standard maternity services.

Children’s healthcare: GKV covers medical care for children and teenagers free of charge until age 18. Pediatricians can be consulted directly and generally look after children until around age 12, after which a general practitioner usually takes over. Children’s hospitals provide both emergency and outpatient services, and all recommended vaccinations in the national schedule are free.

How do dental care, clinics, and pharmacies operate?

Dental care: Most dentists (Zahnärzte) participate in GKV. Under public insurance, check-ups and basic treatment for children and adolescents up to 18 are free. For adults, routine services are partly covered, but more expensive work such as crowns, bridges, or implants is often only partly reimbursed, which is why many people buy supplementary dental insurance.

Specialized clinics and centers: Many medical centers focus on specific areas, such as cancer, fertility, or menopause. They bring together different specialists and therapists so that patients can receive coordinated care in one place.

Pharmacies (Apotheken): These are found everywhere and are usually open Monday to Friday and Saturday mornings. An emergency service list is displayed on each pharmacy door to show which nearby pharmacy is open at night or on weekends. With GKV, prescriptions on a pink slip require only a small co-payment. Private patients usually receive a blue slip, pay the full price, and are then reimbursed by their insurer. Because packaging often lacks detailed instructions, patients should always ask the doctor or pharmacist how to take the medicine.

What emergency services are available?

For serious acute problems, people can go directly to a hospital emergency department (Notaufnahme). To call an ambulance (Krankenwagen or Rettungswagen) in a life-threatening situation, dial 112, which is free and works across Europe.

For urgent but non-life-threatening problems outside office hours, there are special telephone numbers:

• 19 242 for an emergency doctor service in some regions,
• 116 117 nationwide for the on-call medical service (ärztlicher Bereitschaftsdienst).

People are encouraged to use emergency rooms only for real emergencies so that staff can focus on the most serious cases. Family doctors can tell patients about local out-of-hours services in advance.

What are the main institutions in the German healthcare system?

Many of the bodies already mentioned also appear again here, as they play several roles at once: they regulate, plan, and supervise care across the country.

What is the role of the Federal Ministry of Health (BMG)?

The BMG is responsible at federal level for health and long-term care policy. Its main tasks are to:

• Draft and update health laws,
• Issue regulations and guidelines,
• Oversee central public health agencies.

By controlling agencies such as BfArM, PEI, and the RKI, the ministry sets the rules for medicine approval, vaccine safety, and disease control.

What does the Federal Joint Committee (G-BA) do?

Within the self-governing structure, the G-BA is the central decision-maker for which services GKV pays for. It:

• Sets coverage rules for treatments, medicines, and diagnostics,
• Defines quality and qualification standards,
• Issues binding directives for doctors, hospitals, and sickness funds.

It bases its decisions on scientific evaluations from IQWiG and IQTIG, but also listens to patient representatives. In this way, medical evidence and patient interests enter the rule-making process together.

How do providers and associations shape the system?

Provider associations and professional chambers help decide how care is organized on the ground. They:

• Plan where practices and hospitals are located,
• Negotiate fees with sickness funds,
• Monitor billing and quality,
• Run professional training and handle disciplinary issues.

Because nearly all practicing doctors, dentists, and other licensed professionals must belong to their chambers and KV/KZV organizations, these bodies have a big influence on day-to-day healthcare.

What does the German healthcare system cover?

As already described, German health insurance covers a broad catalog of services. This section repeats and widens some key points because coverage is central to how the system is judged.

What services are available through public health insurance?

GKV provides a safety net that covers nearly all necessary medical services people need in everyday life:

The G-BA updates the benefits catalog regularly in light of new medical evidence and cost considerations.

What types of care are included (outpatient, inpatient, rehabilitation)?

The three main forms of care-outpatient, inpatient, and rehab-work together as a chain: early treatment in outpatient settings, intensive care when needed in hospitals, and later support through rehabilitation. Many people move through all three steps during major illnesses or after accidents.

What types of healthcare services does Germany offer?

This section repeats some points about service types with more focus on practical aspects of using them.

How does outpatient care in Germany function?

Outpatient care is the backbone of daily healthcare use. Key points:

• Most people have a regular family doctor.
• Direct access to many specialists is possible, but a referral can help coordination.
• Group practices and MVZ can provide many services under one roof, sometimes including day surgery.
• Most providers hold a GKV accreditation (Kassenzulassung), meaning statutory insurers pay them directly.

What is provided by German hospitals and inpatient care?

Hospitals handle everything that cannot be safely done on an outpatient basis. In addition to acute care, many hospitals run outpatient clinics and specialized centers, reducing the strict border between ambulatory and hospital sectors.

Payment uses diagnosis-related groups (DRGs), where hospitals receive a fixed amount per case based on the diagnosis and procedures, rather than for each day of stay. This payment model encourages efficient use of beds and may shorten stays.

What are the options for mental health, women’s health, and children’s healthcare?

The same system that pays for general health care also pays for specialized areas. Mental health, women’s health, and children’s care are largely integrated into standard GKV benefits, which means people do not need separate insurance to access these services.

How do dental care, clinics, and pharmacies operate?

As already mentioned, dental coverage is more limited for adults, which is why extra dental insurance is common. Specialized clinics and pharmacies tie the network together by offering focused services (e.g., cancer centers) and medication supply.

What emergency services are available?

Emergency care is guaranteed to everyone in Germany, regardless of insurance type. Hospitals may later bill the appropriate insurer, but nobody is turned away in an acute life-threatening situation.

How does the economics of German healthcare affect patients?

Funding rules shape how much individuals pay and how easy it is for them to access care without financial hardship.

What are the costs of health insurance and medical care?

For people in GKV:

• Premiums: About 14.6% of gross wage plus a small extra fund-specific contribution, split evenly between worker and employer, up to the income cap.
• Doctor visits: The old quarterly “practice fee” (about €10-15) has been abolished; currently, there is generally no fee just for seeing a doctor, though some special services cost extra.
• Medicines: Co-payments for prescriptions are usually €5-10 per item, with children often exempt.
• Hospital stays: Around €10 per day for up to 28 days per year.

There is an annual cap on co-payments: 2% of household gross income, or 1% for people with chronic conditions who meet certain criteria. Once this limit is reached, further co-payments for that year are waived. This prevents major medical debt.

For PKV members, premiums depend on age, health, and chosen benefits. They can be lower than GKV for young, healthy high earners but may rise in later life, even though ageing reserves are supposed to soften this effect.

How are drug prices and healthcare expenditures regulated?

Germany uses several tools to control spending on drugs and other services:

• Discount agreements between sickness funds and manufacturers,
• Price freezes and increased mandatory discounts in some periods,
• Reference pricing groups for similar medicines, limiting what GKV will reimburse,
• Higher co-payments for some new, expensive drugs unless they show clear added benefit.

Total health spending is high by international standards. In 2010, it was about 11.6% of GDP, more than €5,000 per person per year. The G-BA’s coverage decisions directly influence what the system pays for and help keep costs under control while maintaining access.

How do waiting times and capacity impact access?

Germany usually has shorter waiting times than many other countries for specialist visits and planned surgery. Surveys show that a high share of patients obtain specialist appointments within four weeks and face little delay for many elective procedures.

Several factors support this:

• A large hospital sector with many beds,
• High numbers of intensive care beds,
• Significant use of day surgery and outpatient procedures,
• Payment systems that reward activity (fee-for-service for doctors, DRGs for hospitals).

However, waiting times are not equal everywhere. Some regions, especially in the east, report longer waits for certain services. Staff shortages after the COVID-19 pandemic-more than 20,000 open positions in hospitals-also threaten to extend waiting times and put pressure on quality in some departments.

What is changing in the German healthcare system?

The system faces new challenges and is under constant discussion. Demographic change, new technologies, and workforce shortages all play a role in current debates.

What recent reforms and challenges are being discussed?

One of the biggest issues is population ageing. The pay-as-you-go GKV model relies on workers financing retirees. With forecasts showing that around one-third of the population will be 60 or older by 2050, there will be fewer contributors and more people drawing benefits. This creates pressure to adjust contribution rates, benefits, or both.

A government commission has proposed changes to hospital payment and planning to strengthen outpatient services within or alongside hospitals and to ease the strict split between ambulatory and inpatient sectors. The aim is to move suitable treatments out of full inpatient care into less costly and more flexible settings where possible.

Another topic is the ongoing shortage of nurses and other health professionals. This limits the ability of hospitals to use all available beds and may cause delays. Debates continue about working conditions, pay, training capacity, and recruitment from abroad.

There is also ongoing discussion about how to balance solidarity and competition among sickness funds, how transparent quality data should be, and how to compare hospitals and doctors openly. Many experts argue that a mixed model-social insurance with regulated competition-remains the most suitable for Germany, but details are continually adjusted.

What resources and vocabulary help you use the German healthcare system?

For people new to Germany, some basic German terms and reliable information sources make it much easier to get around the system.

What German healthcare terms are most useful?

Key words you will often encounter:

• Krankenversicherung: Health insurance.
• Gesetzliche Krankenversicherung (GKV): Statutory (public) health insurance.
• Private Krankenversicherung (PKV): Private health insurance.
• Krankenkasse: Sickness fund, a GKV insurance provider.
• Hausarzt: Family doctor / general practitioner.
• Facharzt: Specialist doctor.
• Arzt / Ärztin: Doctor (male / female).
• Krankenhaus: Hospital.
• Notaufnahme: Emergency room.
• Ambulante Versorgung: Outpatient care.
• Stationäre Behandlung: Inpatient treatment.
• Reha: Rehabilitation.
• Gesundheitskarte: Health insurance card.
• Zuzahlung: Co-payment.
• Rezept: Prescription.
• Apotheke: Pharmacy.
• Pflegeversicherung: Long-term care insurance (mandatory in Germany).
• Ich brauche einen Krankenwagen: I need an ambulance.
• Ich brauche einen Arzt: I need a doctor.
• Herzinfarkt: Heart attack.

Where can you find more information and official guidance?

Helpful sources for reliable information include:

• Bundesministerium für Gesundheit (BMG): Official information on health and long-term care laws and reforms.
• Gemeinsamer Bundesausschuss (G-BA): Details on which services and treatments GKV covers and how care is regulated.
• Kassenzahnärztliche Bundesvereinigung (KZBV): Information on dental care in the GKV system and a search for GKV dentists.
• Aponet.de: Search tool for local pharmacies and out-of-hours pharmacy services.
• Unabhängige Patientenberatung Deutschland (UPD): Independent patient advice service offering free help, often in several languages.
• InformedHealth.org / gesundheitsinformation.de: Evidence-based health information from IQWiG, explaining diseases, treatments, and the German care context in clear language.

These sites can give you a good overview of the system and help you prepare for appointments. For personal health questions and treatment decisions, you still need to talk to a doctor or other medical professional.