Table of Contents:
Healthcare System Overview: How Is the Healthcare System Structured? (Public/Private hospitals/clinics and who can access them)
The German healthcare system is divided into three main areas: outpatient care, inpatient care (the hospital sector), and rehabilitation facilities.
In Germany, outpatient care (ambulante Versorgung) is mainly provided by self-employed doctors, dentists, psychotherapists, and other healthcare professionals in their own practices. Outpatient care is also referred to as primary care and includes types of secondary care.
If you have to stay overnight in a hospital for treatment, this is referred to as inpatient treatment (stationäre Behandlung). Most commonly, this takes place in a hospital.
Primary care is the first point of contact for patients. It includes family doctors, general practitioners, and pediatricians. Patients can see a family doctor or general practitioner for most of their healthcare needs.
Secondary care is provided by specialists. Patients can see a specialist for a variety of reasons, such as needing surgery or having a long-term illness. Secondary care is usually provided in hospitals or clinics.
Healthcare in Germany is, in essence, a mix of public and private services. The public sector, which is what the majority (90%) of residents use, is financed by compulsory social security contributions that are paid by both patients and their employers through their mandatory public health insurance plans, also known as statuary health insurance (gesetzliche Krankenversicherung – GKV).
The public/statutory healthcare system operates by the Principle of Solidarity, which states that everyone covered by statutory insurance has an equal right to medical care and continued payment of wages when ill – regardless of their income and premium level. As the premiums are based on income, this means that the rich can help the poor and the healthy can help the ill.
There are a total of 110 statuary health insurance providers from which residents can choose. These are competing, not-for-profit, nongovernmental health insurance providers known as sickness funds (Krankenkassen)
The healthcare system is self-governing. Although the Government has strong regulatory control, it does not play a direct role in healthcare delivery.
The Federal Ministry of Health (Bundesministerium für Gesundheit – BMG) is responsible for policy- making at the federal level. Its tasks include developing laws and drawing up administrative guidelines for the self-governing activities within the healthcare system.
The Federal Joint Committee (G-BA), which is supervised by the Federal Ministry of Health, is the highest decision-making body within the self-governing healthcare system. Its members represent doctors, dentists, psychotherapists, statutory insurers, hospitals, and patients. As the central entity of federal-level self-governance, the Federal Joint Committee makes decisions concerning which medical services will be covered by the statutory insurers and what form that coverage will take, as well as being responsible for healthcare quality assurance.
For a comprehensive list of the important healthcare providers, institutions, and associations within the self-governing healthcare system, please visit: https://www.ncbi.nlm.nih.gov/books/NBK298834/.
Primary Care: What Doctor to Go to First
A family doctor (Hausartz) is your first point of contact if you are ill or have any other health problems or concerns. General practitioners, internists, and pediatricians are all family doctors.
In essence, patients can see a family doctor or general practitioner for most of their healthcare needs (preventative care, acute care, treatment of common viruses and diseases, etc.). It should be noted that you are not required to be registered with any particular family doctor and are free to choose which one you see.
These doctors will also refer you to the right kind of specialist if needed. For example, they might suggest a skin specialist (dermatologist) or cardiologist.
However, it is also possible to book appointments with specific specialists without a referral from your family doctor.
Remember that, in cases of emergency, you can go to the emergency room at the nearest hospital or call an ambulance by dialing 112.
How to Find a Doctor
You can find a family doctor/general practitioner in a variety of ways.
The easiest way is to use an online search engine; it is important, however, that you use a trusted search engine provider.
There are numerous doctor search engines provided by trusted organizations such as the National Association of Statutory Health Insurance Physicians, National Association of Statutory Health Insurance Funds (GKV – Spitzenverband), and Association of Private Health Insurance.
If you have statuary health insurance, feel free to use those provided by the insurance and physician associations. If you have private health insurance, then we recommend using the Private Health Insurance search engine.
Making Appointments with a Doctor
The standard way of booking an appointment is to make a phone call to the doctor’s office (Praxis), setting up an appointment with the secretary. After your appointment, it’s common to schedule the next appointment with the secretary if a follow-up is needed.
If you urgently need an appointment, some doctor’s offices and clinics offer walk-in appointments (Sprechzeiten) during their open hours. You just simply turn up and wait to be seen; however, it may take considerable time – up to a few hours.
How Insurance and Payment Works
All German citizens and residents living in Germany need to have health insurance.
Note: Tourists are exempt from this requirement but will often need to have travel insurance as part of their visa requirements.
There are two types of health insurance:
Statutory/Public health insurance (Gesetzliche Krankenversicherung – GKV) and private health insurance (Private Krankenversicherung – PKV).
Statutory/Public health insurance offers basic coverage, which includes doctor’s visits, hospital stays, prescription drugs, and some dental and optical care. You can also purchase supplemental insurance to cover additional costs, such as further dental work.
Everyone is entitled to take out public health insurance. It is the most common option, with 90% of the population holding a statuary health insurance plan. Not everyone, however, is allowed to take out private health insurance, as there are certain criteria that must be met before you are eligible. These criteria depend on your income and occupation.
Insurance Cost
The cost of statuary health insurance depends on a percentage of your income. This amount is usually 14.6% and is split between you and your employer. There is also a supplementary contribution (1% of wages, on average). There is a maximum amount you can pay each month as well as a minimum, which is usually 210 euros. It should be noted there are exceptions and reduced rates for certain groups, such as students.
Another important aspect of statutory health insurance is that it does not increase due to pre- conditions or other health problems.
On the other hand, the cost of private health insurance varies greatly depending on your health, age, and the coverage plan you choose. These rates will definitely be impacted by any existing pre- conditions.
The cost of the monthly premium for private health insurance plans can be reduced by choosing to include a deductible, which is the amount of money that must be paid out of pocket before the insurer begins to reimburse costs.
This option of including a deductible does not really exist for statutory health insurance plans.
Payment
If you have public health insurance, you will need to bring your health insurance card (Gesundheitskarte) with you.
Private health insurance patients will usually receive a bill that they can forward to their insurance provider.
Secondary Care: Specialists
Secondary care (and tertiary care) is provided by specialists (Fach Arzt). Patients can see a specialist for a variety of reasons, such as needing an evaluation from an expert in the field, advanced treatment including surgery, or if they have a long-term illness.
Secondary care is usually provided in hospitals or clinics. You are usually referred to a specialist by your family doctor, but you can also book appointments directly with some types of specialists.
Many specialists will be located in joint practices and medical care centers with two or more doctors or other healthcare professionals specializing in a field working together. Larger joint practices can often offer services that are usually only available in hospitals, like special diagnostic examinations or day surgery. Because of this, these practices are sometimes referred to as practice hospitals (Praxiskliniken).
Dental
The dental care system in Germany is a public-private system.
Basic and emergency dental care is covered by statutory health insurance and most private health insurance plans. However, anything extra (e.g., teeth whitening) requires you to pay out of pocket or take out extra coverage via a private insurance plan. Patients that are not eligible for private health insurance under normal conditions can take out these extra coverage plans as well.
Mental Healthcare
Mental healthcare in Germany is provided by psychiatrists, psychologists, and psychotherapists. Psychiatrists are doctors who have special training in psychiatry. They can prescribe medication and perform surgery. Psychologists are qualified to diagnose mental illnesses and provide therapy. Psychotherapists are not qualified to diagnose mental illnesses, but they can provide therapy. You can book an appointment with the aforementioned mental healthcare specialists without a referral from your family doctor/general practitioner.