The German Model
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This health-system model, named after a 19th-century German chancellor, uses insurance funds financed largely through employers and employees
What is the Bismarck model?
Germany's required insurance contributions are primarily linked to this rather than to a person's medical history
What is income/wages?
True or false: Germans generally have a choice among physicians rather than being assigned one doctor by the government.
What is true?
German outpatient physicians are commonly paid using this familiar method.
What is fee-for-service?
Germany and the United States both rely heavily on multiple insurers rather than a single national government insurer. Germany differs because it requires strictly essentially everyone to have this while USA does not
What is health insurance coverage?
In Germany, having this is mandatory for residents.
What is health insurance? Germany requires statutory or qualifying private insurance.
The cost of insurance falls on this group in Germany
What is Employers and employees?
Employers and employees generally do this with required insurance contributions.
This percentage of Germans reported unmet health care needs in recent OECD data: 0.8%, 8%, or 18%?
What is 0.8%? The OECD average was 3.4%
German hospitals are paid using this payment system
What are DRGs (diagnosis related groups)?
Predetermined payments based on diagnoses using this payment system
Germany demonstrates that universal coverage does not necessarily require this system used in the United Kingdom.
What is a government-run National Health Service?
Roughly this percentage of Germans were enrolled in statutory health insurance in 2025
What is 89%? OECD reports about 89.0% in SHI, 10.4% in substitutive private insurance, with only about 0.1% uninsured.
Germany spends approximately this percentage of GDP on health care.
What is 12.3% of GPD? Compared to 9.3% on average in the OECD
Besides primary and hospital care, statutory insurance covers services such as maternity care, preventive care, rehabilitation, and this type of care at the end of life.
What is palliative care?
True or false: German physicians generally treat both publicly and privately insured patients.
What is true? Providers generally treat patients with either SHI or PHI.
One German feature that could be examined in a U.S. affordability discussion is this limit on how much an insured person pays in covered copayments relative to income.
What is an income-based out-of-pocket cap?
These competing, nonprofit, nongovernmental organizations provide health insurance
What are sickness funds? (Non-profit law corporations)
Germany spends about this much per person on health in purchasing-power-adjusted U.S. dollars: $3,000, $6,000, or $9,400?
What is about $9,400? OECD's latest comparable figure is $9,365 per capita, versus a $5,967 OECD average.
German patients can choose among these competing insurers within the statutory system.
What are sickness funds?
One challenge for German physicians is that outpatient and inpatient care have historically been managed separately, producing problems with this.
What is care coordination/fragmentation?
If the U.S. wanted to borrow from Germany without copying Germany entirely, name one German mechanism that could potentially improve either access, affordability, or fairness, and explain the tradeoff
mandatory universal insurance, income-related contributions, nonprofit competing insurance funds, standardized benefits, income-related cost-sharing limits, or stronger regulation of prices.
True or false: Germany has a government-run National Health Service like in Britain where most physicians work directly for the government.
What is false? In Germany most physicians are independent and hospitals are as well.
German mandatory-insurance copayments generally cannot exceed this percentage of gross annual income, with a lower limit for chronically ill patients.
What is 2%? The limit is generally 2%, or 1% for qualifying chronic illness.
Scenario: “Anna is a German employee who develops diabetes. Her insurance company announces that because she now has diabetes, it will terminate her statutory coverage. Is that how Germany's system works?”
What is no?
Scenario: You’re a German rural physician. Your patient has excellent insurance coverage, but your region cannot recruit enough clinicians. What system problem does this illustrate?
What are workforce shortages/geographic access problems? Germany continues to face shortages, particularly in rural areas.