How is the German healthcare system set up?

The German healthcare system is built around a broad network of hospitals, healthcare practices and pharmacies. It provides care for around 83 million citizens.(1)

In Germany, health insurance is compulsory. The system is dual, comprising public health insurance (Gesetzliche Krankenversicherung, GKV) and private health insurance (Private Krankenversicherung, PKV).(2)

Public health insurance (GKV)

Approximately 90 % of the population are covered by public health insurance. Funding is contribution-based and underpinned by the solidarity principle (Solidaritätsprinzip). This means that those with higher incomes pay higher contributions, but everyone is entitled to the same medical services.(1)

Private health insurance (PKV)

The remaining 10 % are covered by private health insurance, with premiums calculated individually based on age, pre-existing conditions, and risk factors.(1)

How is the healthcare system funded?

Public health insurance (GKV)

Public health insurance (GKV) is funded through the Health Fund (Gesundheitsfonds). It is financed by contributions from employees and employers, as well as payments from the German Pension Insurance (Deutsche Rentenversicherung, DRV) and the Federal Employment Agency (Bundesagentur für Arbeit, BA). There are also subsidies from tax revenues.(1)

How much do employees pay?

The GKV contribution rate currently stands at 14.6 % (as of 26.11.2025) of gross income. In addition, there is a supplementary contribution (Zusatzbeitrag), which varies slightly between health insurance funds. Employers and employees each pay half of the contribution.(3)

Who pays for unemployed people and pensioners?

The Federal Employment Agency (Bundesagentur für Arbeit, BA) and the German Pension Insurance also pay contributions on behalf of unemployed individuals and pensioners.(1)

Private health insurance (PKV)

Private health insurance (PKV) is funded on a capital-reserve basis (Kapitaldeckungsverfahren). Premiums are determined by age, individual pre-existing conditions, and health risks. They increase with age.(4)

What services are included in medical care?

The GKV benefits catalogue includes mandatory standard services as well as optional benefits set out in the insurers’ statutes (Satzungsleistungen).(5)

Standard services include:

Outpatient care, including psychiatric and psychotherapeutic services
Dental treatment and dental prosthetics
Inpatient treatment, including rehabilitation and specialist clinics
Medicines, dressings, medical aids, and therapies (Heilmittel)
Primary prevention, such as smoking cessation and health promotion
Cancer screening
Home nursing care
Services for pregnancy and maternity
Cash benefits, such as sickness benefit (Krankengeld), and supplementary services, such as home help.(5,6)

Good to know:

Cosmetic procedures, travel medicine check-ups, and sports medicine examinations are not included in the benefits catalogue.(5) Many doctors also offer individual health services (Individuelle Gesundheitsleistungen, IGeL), which must be paid for privately.(5)

What sets the German healthcare system apart?

The German healthcare system is one of the most expensive healthcare systems in the world. In international comparison, Germany ranks third — behind the USA and Canada — spending around 12 to 13 % of its gross domestic product (GDP) on healthcare.(4)

In contrast to countries such as Sweden, which has a state-run healthcare system with a single social insurance scheme, the German healthcare system is characterised by its dual insurance model and principle of self-governance (Selbstverwaltungsprinzip).(2,7)

Those covered by public health insurance (GKV) have direct access to medical services without having to pay up front.

Challenges

The German healthcare system also faces challenges. In particular, demographic change, the shortage of skilled healthcare workers, and rising demand from an ever‑ageing population are placing increasing pressure on the system. The administrative burden is also growing.(8,9)

Further priorities for health policy include addressing climate change, infectious diseases, and the growing problem of antibiotic resistance.(8)

The information provided is for general information only and must not be used as a substitute for a medical diagnosis or treatment by a doctor. Self-diagnosis and self-treatment are strongly discouraged.