In Germany’s healthcare system, which goes back to Otto von Bismarck’s social security programme of the 1880s, anyone residing in the country is required to take out a health insurance plan.
About 85% of the population do this by taking out insurance with one of the country’s 124 non-profit Krankenkassen or “sickness funds”: public insurers, many of whom are small and linked to trade unions. Membership rates are about 15% of monthly salary, half of which is paid by employers.
Those who earn more than €4,350 ($4,650) a month can take out insurance with a private company, an option that is mainly popular with freelancers and the self-employed. For welfare recipients, health insurance membership is covered by local authorities.
Membership covers GP and registered specialists as well as basic dental care. If you are taken to hospital, your public health insurance kicks in once you are charged more than €10 a day, covering inpatient care with the doctor on duty at your nearest hospital.
It doesn’t cover private doctors or private rooms at a hospital, homeopathic treatment or more advanced dental treatment. Patients pay for 10% of prescription drugs, with a minimum of €5 and a limit of €10 per medication per prescription.
Since 2013, patients in Germany don't need to pay a consultation fee when seeing a doctor. They can also go straight to a specialist, rather than waiting to be referred by a GP.
Almost all visits to the doctor (often a specialist, rather than general practitioner) will generate “co-pays” for the patient and revenue streams for the physician that some fear encourages excessive testing and intervention: a consumer, rather than care-led, culture.
Preventive medicine and public health are harder to incentivise. Patchy access to insurance can leave emergency rooms clogged with chronic conditions. Obesity and mental illness often go entirely untreated.
Though the system fosters excellence and innovation in places, the messy combination of underinsurance and overinsurance has left the US with the highest healthcare costs in the developed world and some of the worst overall health outcomes.