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Who pays in the event of sickness?

In Germany, health insurance companies pay the costs of healthcare - you will find answers to your questions here.

Health insurance companies pay for medical care in Germany.
Health insurance companies pay for medical care in Germany. © picture alliance/dpa

Funding of Germany’s healthcare is based on the system of health insurance. Thehealth insurance companies pay for the healthcare needed by insured individuals. This means that everyone who is legally resident in Germany has access to medical care.

Which types of health insurance are there in Germany?

Health insurance in Germany is compulsory, which means that everyone who lives in the country must be covered. Uniquely in Europe, two systems exist side-by-side in Germany: statutory health insurance and private health insurance. Roughly 74 million people, i.e. nearly 90 percent of the population, are insured in the nearly 100 statutory health insurance funds. Around nine million people have private cover.

Why is insurance compulsory?

A social compact exists in Germany, according to which no citizen in a modern welfare state should be without protection in the event of sickness or injury. Depending on the medical condition, the costs of treatment can very quickly exceed a patient’s financial resources. That’s why everyone resident in Germany must have health insurance. Everyone is free to choose the health insurance fund they wish to cover them.

What is the difference between statutory and private health insurance?

Statutory insurance is based on the solidarity principle: Premiums are determined by the financial means of the members, but the cover provided is the same for everyone. This applies not only to those who pay for their insurance, but also to the roughly 16 million family members who receive free joint cover. The system is therefore based on a “solidarity adjustment” between the sick and the healthy, between people with good earnings and those with lower earnings, between the young and the old, and between single persons and families. Any shortfall in premiums is offset from tax revenues. Voluntary additional cover can be used to supplement the benefits provided by statutory health insurance. Doctors and hospitals invoice the health insurance funds directly.

Private health insurance is only available to those whose earnings exceed a specific threshold and to civil servants. Patients initially pay their medical bills themselves and are then reimbursed by their health insurance company.

What is meant in Germany by the “principle of self-governance”?

In many countries, such as the UK, Sweden or Italy, the state ensures basic medical care. In Germany, the state stipulates the framework for healthcare by law, but health insurance funds, associations of statutory health insurance physicians and hospitals are themselves responsible for determining how this is implemented.

Who invented health insurance?

The world’s first system of compulsory health insurance was introduced in 1883 by the German Chancellor Otto von Bismarck for workers and state employees on a low annual income. For people at the time, sickness or an accident at work almost always meant plunging into complete poverty. For this reason, though also for fear of political radicalisation, health insurance was invented and introduced in the German Empire.

Note: If you are planning to come to live in Germany, you will find information about health insurance here.