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Germany

Population (2010): 81,777,000
GDP per capita, US$ PPP at current prices (2011) 39,518.34
Health expenditure per capita, US$ PPP (2010): 4,338.4
Life expectancy at birth, years (2010): 80,5

Based on the Bismarck model it is built up of statutory health insurance (SHI) funding and a private/public mix of providers. The SHIs is part of the social insurance system as well as pension insurance, unemployment insurance, accident insurance and nursing care insurance, regulated by the Social Code Book (SGB). Germany is the only country in the European Union, in which the SHI coexists with private health insurance, which offers substitutive, supplementary and complementary insurance and coexists in separation from SHI funding and pooling arrangements, though both have the same service providers. Since January 2009 all residents of Germany are legally required to have health insurance.

In 2009 around 85% of the population was covered by statutory health insurance and around 10,8% by private health insurance. Another 4% of the population were secured by free governmental medical care, which applies to soldiers, civil servants, police men, welfare recipients and asylum seekers and 0,25% were uninsured, which mainly included the self-employed, rich and poor, and persons who had voluntary insurance but failed to pay their contributions.

Ambulatory health care is mainly provided by private for-profit providers; acute care and long-term care are commonly provided by not-for-profit or for-profit providers.  Germany has a mix of public hospitals, private not-for-profit hospitals, and for-profit hospitals.  Since January 2004, all acute hospitals are required to implement the German modification of DRG-system.

Health System Data in Germany

Important sources of aggregated nationwide health data are the Federal Bureau of Statistics (Statistisches Bundesamt) and the Federal Health Reporting System (Gesundheitsberichterstattung des Bundes) which offer free access to multifaceted data from more than 100 different sources. The health data and health information is updated on a regular basis and continuously enhanced. Continuous collection of health data on an individual level through nationally representative health surveys are carried out by Robert-Koch-Institute, findings and results are accessible in numerous publications and reports (www.rki.de). Various health data can also be drawn from the social health insurance system, which covers approximately 86% of the population; such data include statistics on expenditure, hospitalization as well as data on prescription drugs. Aditionally, a regular nationwide survey known as the Microcensus gathers subjective data on the perceived health status of a representative sample of the German population.


Health Status

Aggregated data

  • DESTATIS (Federal Bureau of Statistics) : demographic data on birth and fertility rates, mortality, life expectancy and population-related data on the causes of death
  • GBE des Bundes (Federal Health Reporting System): statistics on diseases and health problems of the German population. Data on Health status and health-relevant behaviour such as diseases, traffic accidents, work place injuries, smoking behaviour, drugs, alcohol and other risk behaviours.
  • ZfKD (German Centre for Cancer Registry Data): contains epidemiological data on lung, liver, breast and other cancer types on a federal level. Population-based cancer registries in each German federal state transfer data to the ZfKD, as required by the Federal Cancer Registry Data Act (Bundeskrebsregisterdatengesetz). The transferred data are combined, quality-checked, analysed and evaluated, and the results published in collaboration with the public health institutions of the federal states. The dataset is also available on regional level.
  • GEKID (Association of Population-based Cancer Registries in Germany): epidemiological data on cancer with an interactive Cancer-Atlas with incidents and mortality in each federal state.
  • RKI (Robert Koch Institute): federal epidemiological centre for infectious diseases; collects epidemiological data on a number of notifiable infectious diseases. The Epidemiological Bulletin publishes weekly data reports since 1997. The SurvStat , a simplified online database, contains current prevalence data for infectious diseases such as measles, tuberculosis, hepatitis and etc. Yearly published Epidemiological Yearbooks contain summarized data analysis for each year since 2001. Statistical data and reports on diseases and health problems of the German population, such as diabetes mellitus, cardio-vascular diseases, cancer and notifiable infectious diseases are also regularly published by GBE des Bundes.
  • Paul-Ehrlich-Institute: founder of German Hemophilia Registry In 2007, with the financial support of the German Federal Ministry of Health, with the purpose to collect personal health data of patients (diagnostic and therapeutic data).
  • HelmholtzZentrum: founder of German Myocardial Infarction register which contains a summary of data from various cardiovascular studies.

Individual level data

  • Nationwide population-based cross-sectional surveys conducted by Robert Koch Institute (RKI) as a part of its nationwide health monitoring:
  • GEDA (German Health Update survey) - a telephone health survey that took place in 2009, 2010 and 2012 and focused on chronic diseases, health related behavior, socio-demographic characteristics, vaccinations etc. pfeil zu
  • DEGS (German Health Interview and Examination for Adults) - representative data on the health status, health-related behavior, healthcare and living conditions of adults residing in Germany between 2008 and 2011. pfeil zu
  • KiGGS (German Health Interview and Examination Survey for Children and Adolescents) – a project funded by the Federal Ministry of Health (BMG), the Federal Ministry for Education and Research (BMBF), and the Federal Ministry of Food, Agriculture and Consumer Protection (BMELV) to study the health of children and adolescents between 0 and 17 in Germany between 2003 and 2006. pfeil zu 

Quality (valued outcomes)

Individual level data

  • WIDO Monitoring (Wissenschaftliches Institut der AOK) conducts annual surveys of AOK statutory insurance holders since 1998 on current healthcare policy topics, such as expectations from the health care reform, switching health insurance, expectations from statutory health insurance, waiting time, self medication, subjective health, etc. pfeil zu
  • Quality assurance with routine data (QSR) measures quality of stationary care using anonymous administrative and hospital routine data of patients. QSR is a mutual project of AOK statutory health Insurance and HELIOS clinics, therefore only data of AOK insured patients are considered. pfeil zu
  • German Endoprosthesis Register (EPRD) collects relevant patient data from AOK Statutory Health Insurance and medical records from some state Hospitals to Endoprosthetic surgical procedures in order to identify issues and improve quality of the procedure.
  • Patient Satisfaction Survey is a representative study in the outpatient care in Germany conducted by WINEG (Wissenschaftliches Institut der TK). pfeil zu
  • The Weisse Liste internet portal, a joint projectof the BertelsmannFoundation and theumbrella organizationof the largestpatient and consumerorganizations, represents outcomes of surveys on patient satisfaction with hospital services, nursing facilities and doctors. Survey is carried out in cooperation with AOK and BARMER GEK health insurance companies (in German only).
  • Europe survey (Europabefragung) conducted by WINEG in 2009, 2010 and 2012 on patient satisfaction with quality of cross-border outpatient care for German population. pfeil zu

Efficiency/Economy

Physical Inputs (Infrastructure)

Aggregate data

Activity/Utilization

Aggregate data

  • GBE des Bundes at the national and regional levels: detailed information on medical procedures, doctor visits, number of hospital admissions, hospital personnel, average lengths of stay, surgeries, etc.
  • Krankenhaus Barometer is an annual representative survey conducted in German hospitals since 2000 on current health policy and hospital policy issues. This survey is a project of a German Hospital Institute (DKI).

Individual level data

  • WIDO Monitoring ( Wissenschaftliches Institut der AOK) contains data from surveys on integrated health care, supplementary insurance, participation in screening procedures, etc. pfeil zu

Cost and Expenditure

Aggregate data

  • GBE des Bundes provides reports on German health expenditures in outpatient and inpatient treatment/rehabilitation, pharmaceuticals, nursing care, health research, specific diseases with the possibility to compare expenditures internationally.
  • The Institute for Hospital Remuneration System ( Institut für das Entgeltsystem im Krankenhaus) is responsible for the introduction, development and maintenance of the new DRG-Payment System in German hospitals. The website contains information about the implementation of DRG-System in Germany, including the most resent DRG Remuneration Catalog.
  • G-DRG-Report Browser is a free database with detailed calculation results per MDC (major diagnostic category) and DRG in 2010/2012 on number of cases, length of stay, costs, age and gender breakdown, etc. The database is provided by Institut für das Entgeltsystem im Krankenhaus (The Institute for Hospital Remuneration System). pfeil zu

Access/Equity (distribution)

Aggregate data

  • DESTATIS provides annual data on socioeconomic background, income and living conditions of German population. Data is collected through Microzensus annually on regional level.
  • 2011 Census is the largest statistical project in Germany, collecting data on basic information on the population, housing space, education and employment as of 9 May 2011. Data will be collected every 10 years. pfeil zu
  • SOEB: Reporting on socio-economic development in Germany.

Individual level data

  • German Socio-Economic Panel Study (SOEP) is a wide-ranging representative longitudinal study of private households, conducted at the German Institute for Economic Research(DIW). Data provide information on household composition, occupational biographies, employment, earnings, health and satisfaction indicators. pfeil zu
  • Kompetenznetz Diabetes Mellitus: a study on Impact of social disparities on type 2 diabetes prevalence and quality of diabetes care in Germany (SP22) using survey data Data from two nationally representative health examination surveys of the adult population carried out by the Robert Koch Institute (GNHIES98, DEGS).

Non-health care determinants

Aggregate Data

  • GBE des Bundes: Data on health determinants and health-relevant behaviour such as nutrition, body weight, physical activity, as well as environmental hazards.

Individual Level Data

  • Nationale Verzehrsstudie II: national survey on nutrition and other determinants of health status (BMI, physical activity, life style factors and sociodemographic data) conducted by Mark-Rubner Institute (MRI) and the Federal Ministry of Food, Agriculture and Consumer Protection (BMELV). pfeil zu
  • Nationales Ernährungsmonitoring (NEMONIT): national survey on nutrition and other determinants of health status (BMI, physical activity, life style factors and sociodemographic data) conducted by Mark-Rubner Institute (MRI) and the Federal Ministry of Food, Agriculture and Consumer Protection (BMELV). pfeil zu
  • DAK Gesundheitsbarometer: regular surveys of people insured with DAK Health Insurance on various health determinants, such as burn-out, alcohol consume, physical activity, back pains, etc. 

Health System Design and Context