6. “GERMANY | Summary.” Columbia Public Heath. Columbia 

University, 2019. https://www.publichealth.columbia.edu/research/comparative-health-policy-library/germany-summary

• In 2020, healthcare spending reached $4.1 trillion ($12,530 per person)
• Medicare spending reached $829.5 billion, taking up 20% of the national health expenditure (NHE)
• Medicaid spending reached 671.2 billion, taking up 16% of NHE
• Private health insurance declined to $1,151.4 billion, consuming 28% of NHE
• Out of pocket spending declined to $388.6 billion, which is 9% of NHE
• National health spending is projected to reach $6.2 trillion by 2028

• German (80%)
• Other European (12%)
• Turkish/Kurds (3.5%)
• Asian (2%) 
• Other (2.5%) ⁶

• Germany’s healthcare system values quality, safety, provision of care, and health resources. However, because the system's structure tends to be fragmented, it is difficult to get a comprehensive picture and assessment of the health care system as a whole. There are some weaknesses in the system's individual parts. Because of the separate systems and programs, it is challenging to gather an accurate evaluation of the system as a whole and create measurable and appropriate goals. Applying a systematic evaluation would allow Germany to improve its healthcare costs and quality of care. ⁷

• In Germany, their health expenditure is 11.25% of its GDP. The healthcare expenditures and benefits of the SHI system contribute to Germany’s strong economy. This is due to healthcare funding being reliable on wage-related health insurance contributions. ⁷

• Germany’s healthcare system has three levels of government: the federal, the state (Länder), and self-governance bodies.
• At the federal level, the Federal Ministry of Health manages the policies for the hospital administration. 
• At the state level, the Länder oversees the planning and financing of the hospital. 
• The self-governance bodies and the Federal Joint Committee govern “...translating legislative objectives into specific regulations,” such as the social health insurance (SHI) funds. ⁷

• Germany is a universal multiplayer healthcare system.
• In Germany, healthcare is financed by funds through mainly insurance premiums. 
• “SHI is financed primarily through mandatory income-related contributions deducted from employers and employees, and tax revenues.”
• “PHI premiums depend on individual health risks. There are different payment systems in place for ambulatory service provision for patients covered under SHI and PHI, and treating PHI patients is generally much more profitable for doctors. This leads to inequalities, with SHI patients being exposed to longer waiting times than patients with PHI (National Association of Statutory Health Insurance Physicians, 2018).”
• “The need to reform the payment system is currently one of the main topics on the political agenda.” ⁷

• Germany’s healthcare insurance is predominantly universal, which means all legal residents have coverage. 
• There are two types of insurance in Germany’s healthcare system: public social health insurance (SHI) and private health insurance (PHI).
• In Germany, those with SHI are generally employees, while those with PHI typically have a higher income or are in a specific professional group. 
• The SHI system covers 87% of the population in Germany, while only 11% is under PHI companies. ⁷