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The German Healthcare System: Key Aspects

The German Health Care System is among the most advanced healthcare systems that provide quality healthcare services, which are not only accessible, but also affordable. What makes the German Health Care System unique across the world is the nature of social health insurance that it offers to Germans. In Germany, social health insurance is mandatory for low- and middle-income earners, but voluntary to high-income earners (Greb, 2007). Thus, the health care system has a dual system of social health insurance, which comprises mandatory and voluntary insurance packages. Mandatory healthcare insurance covers about 80% of the population, while alternative private health insurance and special insurance cover the remaining section of the population.

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The cost of healthcare services in Germany is cheap and reasonable because the level of income determines the cost. Although patients receive the same quality of healthcare services, premiums that people pay are independent of the number of dependents and age of an individual; however, they are dependent on the level of income (Ridic, Gleason, & Ridic, 2012). In addition to reduced cost of healthcare services due to social health insurance, the German Health Care System has enacted reforms, which have increased accessibility of healthcare services and reduced inequalities. Ozeqowski and Sundmacher (2012) report that the parliament passed the Care Structures Act (2012), which aims at facilitating cross-sectoral treatment, improving outpatient care, strengthening innovation, and decentralizing management. The reforms have reduced sectoral barriers and improved efficiency, and thus they have enhanced accessibility of healthcare services.

The limitation of the German Health Care System is that the premiums that social health care insurance charges are increasing at a higher rate than the rate at which income level increases (Greb, 2007). This means that social health insurance premiums would increase disproportionately over a long period. Another limitation is that both private and mandatory insurers receive equal quality of healthcare services from the general practitioners, yet private insurers pay higher premiums than mandatory insurers.

Although the German Health Care System provides quality healthcare services that are accessible and affordable, the system is gradually proving to be cost-ineffective when compared to other health care systems across the world. According to Oduncu (2013), the health care system is rationing healthcare services, as a way of reducing medical costs and increasing cost-effectiveness of the system. Regarding patient satisfaction, a study conducted in Germany reveals that patient satisfaction has been increasing gradually in the past 10 years, with 34% of patients rating the quality of healthcare services as excellent (Koch, Schurmann, & Sawicki, 2010). Increasing patient satisfaction occurs because patients have freedom to choose either specialist care or primary care services. Specialist care and primary care have equal number of healthcare providers (Schlette, Lisa, & Blum, 2009). In this view, the health care system provides quality healthcare services because it has sufficient specialists and primary care providers. Moreover, patients have the freedom of choosing their preferred healthcare providers and services.

Given the advancements that the German Health Care System has made over decades, the system is sustainable despite increasing healthcare costs. The costs of the German Health Care System have increased from 5.9% of gross domestic product in 1970 to 11.6% of gross domestic product in 2013 owing to the increase of the population (Schlette et al., 2009). This means that the healthcare costs have doubled within a period of about 40 years. However, the health care system is undertaking massive reforms to improve efficiency of the system and significantly enhance sustainability of the system.


Greb, S. (2007). Private health insurance in Germany: Consequences of a dual system. Health Policy, 3(2), 29-37.

Koch, K., Schurmann, C., & Sawicki, P. (2010). The German Health Care System in international comparison. Deutsches Ärzteblatt International, 107(24), 427-434.

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Oduncu, S. (2013). Priority-setting, rationing and cost-effectiveness in the German Health Care System. Medicine, Health Care, and Philosophy, 16(3), 327-339.

Ozechowski, S., & Sundmacher, L. (2012). Ensuring access to health care: Germany reforms supply structures to tackle inequalities. Health Policy, 106(2), 105-109.

Ridic, G., Gleason, S., & Ridic, O. (2012). Comparisons of health care systems in the United States, Germany, and Canada. Materia Sociomedica, 24(2), 112-120.

Schlette, S., Lisa, M., & Blum, K. (2009). Integrated primary care in Germany: The road ahead. International Journal of Integrated Care, 9(14), 1-11.

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