In Germany, individuals purchase insurance through a system characterized by public-private partnership. Federal law requires all Germans to hold health insurance, but does not provide coverage directly. In the German system, about 85 percent of residents purchase heavily regulated, non-profit insurance referred to as Gesetzliche Krankenversicherung (Statutory Health Insurance, GKV), approximately 10 percent buy private insurance, and the remaining 5 percent fall into other insurance schemes.

Gesetzliche Krankenversicherung (GKV) covers the majority of Germans.

  • All Germans earning under a yearly adjusted rate (approximately €50,000 per year) are required to purchase GKV from a Krankenkasse.
    • Individuals pay for insurance based on their income, paying 8.2 percent of their gross wages up to €44,550 (in 2011) while their employer contributes an additional 7.3 percent of their gross wages up to €44,550 (in 2011).
  • Krankenkassen (Sickness Funds) are heavily regulated, non-profit insurers who are legally required to accept all applicants and are permitted to sell health insurance (GKV).
    • Traditionally, Krankenkassen were associated with industries, meaning that individuals would purchase GKV through the Krankenkasse in their industry. Today, individuals have greater freedom to choose between Krankenkassen, though they must still buy through their employer.
  • GKV includes complete coverage of most health needs, with the exception of long-term care.
    • GKV does include long-term care, but benefits are usually insufficient and most choose to supplement GKV with private insurance.
    • A council of representatives from the health care industry, the Gemeinsame Bundesausschuss, has legal authority to determine what services must be included in GKV.
  • Providers negotiate with Krankenkassen on a regional basis to determine eligibility.

Civil servants and the self-employed, who are not covered by the employer-based GKV system, purchase private insurance. In addition, individuals earning above approximately €50,000 per year are permitted to opt out of purchasing GKV and purchase private health insurance instead. Private insurance is also heavily regulated, but is generally more flexible and more expensive than GKV.


Health practitioners enter the market by gaining certification from legally mandated regional professional organizations. From there, practitioners may open a practice or join an existing practice, which are mostly private. They may also choose to work as salaried doctors at hospitals.

Hospitals are mostly publicly-owned, accounting for about half of all beds, while non-profit private hospitals make up about a third of all beds.

  • Rob Houck

    Where’s the beef? Can’t we get 20-30 pages on this topic? Of course it will not move the US debate since it’s “foreign”, “socialist”, etc.

    • Jessica

      More analysis will be coming this spring.

  • Ann-Katrin

    German health care system stinks. It’s overpriced and people are encouraged to run to the doctor for everything to even get a small percentage of their cost covered. It is in serious need of a reform. On top of it all you get ill just from trying to leave it if you leave the country and you can’t even legally BE with the health care provider anymore. I have been in Germany for five years, and have been privately insured. Not even the month I actually broke my foot and had to have health care did the health care insurance pay off. It would have been cheaper for me to pay my own hospital bill… All the German system does is encourage doctors and other providers to overcharge. How can something that you in some counties have to pay for yourself (crutches being a good example) otherwise be 10 times more expensive in Germany than in for example the Scandinavian countries?!? Margins, margins, margins. The health care providers are making ridiculous amounts of money misusing a system. I am all for the principle that we all pay a share to make sure everybody gets some coverage but the German system is way too expensive!