Germans can expect to live long lives but further modifying health behaviours is key to improving mortality and morbidity rates

Life expectancy has increased by almost 3 years since 2000 and reached 81 years in 2018. Like other high-income countries, cardiovascular diseases and cancers are the leading causes of death in Germany. Health-related lifestyles and health behavior, such as dietary habits, alcohol consumption and smoking rates have a strong influence on the morbidity and mortality of the population, accounting for nearly 1 in 5 deaths.

Germany spends more on health than most other European countries and provides universal coverage with a broad benefits package

Germany spent €390.6 billion on health in 2018, which corresponds to 11.7% of GDP. The country’s per capita health expenditure is the third highest in the European region (after Switzerland and Norway). Health insurance is compulsory and is provided either under the Social Health Insurance (SHI) scheme or through substitutive private health insurance. SHI covers a broad benefits package, well beyond essential services, and patients can freely choose their physicians, general practitioners and specialists alike. Cost sharing is low, with only 13.6% of health spending coming from household out-of-pocket payments.

There is a strong sectoral separation of services in Germany

Public Health, ambulatory care, hospital care and long-term care are very separate and organized differently in terms of planning, financing, and governance. This fragmentation presents challenges for health care in terms of coordination and continuity of care, quality of services for patients and efficiency in allocating resources.

Quality assurance and increasing efficiency are mainstays of the policy agenda

Key areas of change in recent years have been in assuring equal access in ambulatory care, quality assurance in inpatient care, and strengthening coordination of care. In terms of efficiency, Germany has large human, technical and infrastructural capacities at its disposal and makes frequent use of these resources, with a very high number of services provided across health sectors. This can be seen as achieving a considerable level of technical efficiency. Given the high volumes, however, there are some questions about the oversupply of services.