Editing Healthcare System (Germany)

[[dct:title::Germany]] operates a multi-payer healthcare system, blending both public and private health insurance. All residents are mandated to have health insurance, either through the Statutory Health Insurance (SHI), comprising of 110 sickness funds covering 88% of the population, or through Private Health Insurance (PHI) provided by 41 companies, covering 10% of the population. The remainder, including military personnel, are covered under special schemes.

The Federal Ministry of Health is the primary governmental body overseeing the health system. The delivery of services is managed at the regional level by regional associations of SHI physicians and the regional branches of the Federal Association of Statutory Health Insurance Funds.

Universal healthcare benefits include preventive services, inpatient and outpatient care, prescription drugs (except those explicitly excluded by law or following a benefits assessment), mental health care, dental care, optometric services, rehabilitation, and home care covered by long-term care insurance.

Those earning below a certain threshold are automatically enrolled in the SHI, while those above can choose between SHI or PHI. The healthcare system suffers some fragmentation between inpatient and ambulatory care. Ambulatory care, provided by around 160,000 GPs and specialists, is mostly reimbursed through fee-for-service payments. More than 1900 hospitals provide inpatient care, paid through a Diagnosis-Related Group (DRG) system.

Germany has been advancing digital health records, with the electronic health card as the centerpiece. Claims data is processed by the respective health insurance funds, and disease registries are maintained at both regional and national levels. A Telematics Infrastructure connects healthcare providers, pharmacies, hospitals, and health insurers securely, enhancing data exchange and coordination of care.