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Weinbrenner S, Busse R
In: Rechel B , Dubois C-A, McKee M (eds.) The Health Care Workforce in Europe – Learning from experience. Copenhagen/ Brussels: European Observatory on Health Systems and Policies, S. 33-46





Although one of the largest economies in Europe, Germany has faced increasing budgetary pressure in recent years, owing to high unemployment, changing demographics and the costs of German reunification. Germany spends a comparatively high share of its national wealth on health, ranking third among OECD countries in 2003, with 11.1% of its GDP spent on health (OECD 2004). With respect to health spending per capita, Germany ranks seventh but the increase in real terms accounted for only 1.3%, far below the OECD average of 4.5%. In December 2003, 4.2 million people were employed in the health care sector, constituting 10.7% of the German workforce, according to data from the Federal Statistical Office (Federal Statistical Office 2003a). Health care financing is based on a system of statutory health insurance, comprising multiple sickness funds, that covers almost 87% of the population, with a further 10% of the population (those above a certain income can opt put of the otherwise mandatory system) covered by private health insurance (Federal Statistical Office 2003b). A further mandatory insurance programme
(Pflegeversicherung) was introduced in 1994, in order to ensure access to nursing care for elderly people. All members of statutory sickness funds (including pensioners and unemployed people), as well as people with comprehensive private health insurance, were compulsorily enrolled in the new insurance scheme, making it the first social insurance programme with population-wide membership.

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