as requested a brief summary of German health care:
Germany has Europe's oldest universal health care system. Currently 85% of the population is covered by a basic health insurance plan provided by statute, which provides a standard level of coverage. The remainder opt for private health insurance, which frequently offers additional benefits.
There are two separate systems of health insurance': public health insurance (Gesetzliche Krankenversicherung) and private insurance (Private Krankenversicherung). Both systems struggle with the increasing cost of medical treatment and the changing demography. About 87.5% of the persons with health insurance are members of the public system, while 12.5% are covered by private insurance.
Public insurance
All salaried employees must have a public health insurance. Only public officers, self-employed people and employees with a large income above c. €50,000 (adjusted yearly) may join the private system.
In the Public system the premium
- is set by the Federal Ministry of Health based on a fixed set of covered services as described in the German Social Law (Sozialgesetzbuch - SGB), which limits those services to "economically viable, sufficient, necessary and meaningful services"
- is not dependent on an individual's health condition, but a percentage of salaried income (typically 10-15%, depending on the public health insurance company one is in, where half of that is paid by the employer)
includes family members of any family members, or "registered member" ( Familienversicherung - i.e. husband/wife and children are free)
- is a "pay as you go" system - there is no saving for an individual's higher health costs with rising age or existing conditions.
With an aging population, there is an intrinsic risk that, in the long run, the burden to be carried by the young and working generations for the higher share of elderly will run the public system into a huge deficit or result in high premiums.
Private insurance
In the Private system the premium
* is based on an individual agreement between the insurance company and the individual defining the set of covered services and the percentage of coverage
* depends on the amount of services chosen and the individual risk and entrance age into the private system
* is used to build up savings for the rising health costs at higher age (required by law)
A person that opts out of the public health insurance system and gets private health insurance can not go back later to the public system, even if income drops below the level required for private selection. Since private health insurance is usually more expensive than public health insurance one will be required to pay the higher premiums with less income.
The private system is said to be more stable to a changing demography, due to the savings accumulated over time. However with life expectancy rising the premium will also eventually rise for individuals.
In my subjective opinion works the system well. You get treatment directly and the additional costs for medication are minor.
Nearly every treatment is covered even gender reassignment surgery and abortion.
Maybe the system could get instable in a few years because of changing demography.
so far