Germany, with the world’s oldest social health insurance system, has high health expenditure but the population also enjoys a good health status.

SK/MS – 12/2017

The Country Health Profiles, published on 23 November 2017, are part of the Commission’s two-year health status initiative, designed to provide Member States with guidance in their national policy-making. Included in the profiles are the sustainability and effectiveness of health systems and their accessibility by patients and insured persons. 

High expenditure in Germany, comprehensive services and benefits

The report states that health expenditure per capita in Germany in 2015 was the second highest in the EU. Luxembourg spends the most on health as a proportion of its GDP, Romania the least. Overall, German’s health system offers generous benefits, a high standard of health services and good access to health care for all income groups. 

Life expectancy only on par with EU average

In 2015, life expectancy at birth in Germany was 80.7 years, which is slightly above the EU average. Life expectancy in Italy and Spain is two years higher than Germany, making them the leaders in the EU. Mortality from cardiovascular disease, which continues to be the number one cause of deaths, has fallen significantly, while the number of deaths from dementia is increasing. Tobacco and alcohol consumption has generally declined, but binge drinking remains problematic and is the fifth highest in the EU. Obesity is a growing problem in Germany. 

Better allocation of resources

The report highlights that resources are poorly distributed. This includes oversupply in metropolitan areas and undersupply in rural areas. Inpatient services are often provided in a number of smaller hospitals that lack the required quality. This is attributable to an excessive number of beds in hospitals. The report is also critical of unnecessary surgeries and overprescribing of medicines. On a positive note, the report mentions the high uptake of disease management programmes. 

Strong self-governance is characteristic of the German health system

Self-governing bodies play a significant role in shaping Germany’s health system. However, the Commission also believes that they make it more difficult to push through structural reforms needed to overcome shortcomings in quality and efficiency. The Commission was also critical of Germany’s split system of statutory and private health insurance with regard to longer waiting times for patients with statutory health insurance and the fact that the split system contradicts the principle of solidarity.