The German healthcare system – combining modern medicine with tradition

Germany is among the countries with the best healthcare systems. All of the country's citizens are excellently cared for by a diverse range of hospitals, medical practices and other establishments. The German healthcare system is considered to be the largest employer in Germany, employing over four million. Accounting for a share of 10.4 per cent of the gross domestic product, expenditure on health services in Germany is around 1.5 percentage points above the OECD average.


The invention of social insurance and consequently of health insurance in Germany has been a constant feature throughout history, starting from the German Empire until the present day. The social welfare system that was introduced in the German Empire at the end of the 19th century was the first of its kind in the world. This historical development was also the reason for the separation of inpatient and outpatient care in Germany.


Inpatient hospital treatment

When being admitted to a hospital, each patient signs a “treatment contract” that governs the medical care provided by doctors and nurses and the accommodation and catering services provided in a room with several beds.
If the patient wishes to be accommodated in a one or two-bed room instead of a shared room with several beds, or if they wish the treatment to be administered by senior physicians, they must sign a separate contract with the hospital in question. The costs for such “optional benefits” are either borne by the patients themselves or by a health insurance policy that the patient may have concluded in Germany.
Due to the rising number of medical cases and the growth in the intensity of medical service performance in inpatient treatment in recent decades, the German government passed a law in 2004 to change the basis upon which inpatient care is billed to diagnosis-related groups (DRG). As a result, services provided in hospitals since that time are billed to the health insurance providers or self-paying patients on the basis of a fixed amount that depends on the disease to be treated. This fixed amount is based on the diagnosed disease, the operation and also takes into account its severity.

Outpatient treatment in a doctor's practice

A disease is usually treated or diagnosed in a doctor's practice, after which the patient can go home. The German Medical Fee Scale (Gebührenordnung für Ärzte, GOÄ) provides the basis for the billing of these medical services. Sometimes the diagnosis or the nature of the disease necessitates subsequent inpatient or outpatient hospital care.