Name: The myth of free healthcare in Germany: Inside a system at breaking point | DW News
Uploaded: 2026-03-09T17:28:23.000Z
Duration: 13 min 58 s
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This clinic in Hamburg is open to everyone, including people who have no health insurance.

Official numbers show that around 70,000 people in Germany are uninsured, and

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So in a country that's known for its universal health care, how do these people get medical treatment?

Germany has one of the world's most expensive healthcare systems, but

the quality doesn't always match the price tag.

At the same time, many hospital beds remain unchecked, underused, and bureaucracy is inefficient.

We pay for Mercedes, but we drive a Golf.

We are really in a relatively bad situation, which I haven't seen for many decades.

The German Hospital association has even called 2026 a schicksalz year, a make or break year for the healthcare system.

And the government is promising to implement a major healthcare refor.

Minister Nina Wacken didn't sugarcoat it.

We're dealing with inefficient structures, unsustainable financing, staff shortages, poor digitalization and way too much bureaucracy.

So what exactly is going wrong and what are possible ideas for solutions?

Germany has the most expensive healthcare system in the EU.

In 2023, the country spent around 12% of its GDP for healthcare, more than any other country in the European Union.

However, in terms of avoidable deaths, its performance is just average.

In Germany, more than 83 deaths out of 100,000 inhabitants were considered avoidable.

In Sweden and the Netherlands, it was less than 60 deaths.

Already, 25 years ago, the WHO produced a first international ranking, where we at that time were third expenditures, but

And at that time, the then chairperson of the Academic Advisory Board to the Ministry made his famous sentence.

We pay for a Mercedes, but we drive a Golf in healthcare.

But what makes it so expensive and so inefficient?

Here are some of the common talking points.

An increasingly aging population, an inefficient system of hospitals and clinics with too many beds and low occupancy.

Many unnecessary doctor visits and treatments often done in hospitals instead of an outpatient basis.

Rising costs for medications and treatments, and broad healthcare coverage and benefit packages.

But what do these rising costs actually mean for the average person and for the economy as a whole?

To answer that, we first need to understand how Germany's healthcare system is funded in the first place.

Most people, nearly 75 million, are covered by public insurance.

Half of Health insurance contributions are financed by employers and half by employees.

These contributions have risen steadily in recent years.

In 2026, an average of 70.5% of gross wages will go toward health insurance, regardless of your health status or age.

This applies to everyone with statutory health insurance.

Uniquely in Germany, you can completely opt out of this system.

Around 8.8% of people in Germany have private insurance, mainly high income earners, the self employed and freelancers, which drains financial resources from the statutory system and contributes to the problem.

The insurer's expenses continue to rise while their revenues decline.

In 2026, insurers face a 2 billion euro shortfall.

By 2027, that gap could explode to 12 billion.

One more reason for that, the demographic change.

The number of patients as a percentage of patients above 70, above 80 years old, will considerably increase, and

that is putting additional pressures on the expenditure side.

Germany has one of the highest amounts of hospitals per capita in Europe.

This ensures good access to care, but also creates significant inefficiencies.

We have among the highest numbers of beds per 10,000 patients, and

we are using these beds extensively in international comparisons.

It's demonstrated in many areas that we do treat patients within a full hospital stay, where other countries far more come and do it without a hospital stay in the ambulatory setting.

And the costs for this care are increasing.

With new breakthrough treatments on the horizon, the system is under even more pressure.

At the same time, we see that in the drug industry, in the medical device industry, there is a lot of progress being offered.

Yeah, I mean, if you look at Alzheimer, if you look at cardiovascular diseases, there are some breakthrough therapies approaching.

But then the question is, can we afford to be as generous as in the past to really fund all these therapies?

According to an OECD poll, Germans in 2023 went to the Dr. 9.7 times on average.

This is more than the OECD average of 6.5.

I think there is an overuse because people are used to go to the physicians very regularly and very often.

It's also an incentive aspect from the provider side, because the remuneration system, the fee schedule for physicians, rewards that people come back.

You fill your offices regularly by inviting them to come back.

That's part of the business model of physicians.

On average, the waiting time for an appointment with a specialist In Germany is 36 days.

This is one of the things bothering people with statutory health insurance the most.

For some people, the problem isn't the waiting time, it's getting any treatment at all.

There are people who have no insurance coverage whatsoever.

If the economy is in a crisis, then the number of people without health insurance is increasing as well, because then you are falling out of the labor market.

then the likelihood that you lose your health insurance is there, and

then the health insurance system wants them to pay also the lost contributions of the time when they were not in health insurance, which of course is not an invitation to come back.

So what can these people do when they get sick?

Bronwyn Margolis is managing this free clinic that treats uninsured patients, people who have fallen through the cracks of the health care system.

Kinder mentioned the people living on the streets and people without a secure residency status.

Being uninsured is rarely an isolated problem.

It often goes hand in hand with uncertain residency status or unstable work.

They don't have health insurance because, for example, they can't get work, at least not jobs that come with social insurance.

There are also many day laborers who can only work a few hours here and there.

And of course, their families are affected as well.

By offering multiple types of consultations, the clinic aims to address as many concerns of their patients as possible.