Table 1 Characteristics of statutory and private health insurance in Germany
Characteristic | Statutory Health Insurance | Private Insurance |
|---|---|---|
Principle of insurance | Principle of solidarity. Health care has to be economical and medically necessary. More than 90 % of German inhabitants have statutory health insurance. | Principle of equivalence. Policy of equivalence of service and reward. Less than 10 % of German inhabitants are privately insured. Self-employed persons and persons with an annual salary above 54,900€ have the option of private health insurance. |
Insurance contribution | Health insurance contribution currently 14.6 % of the individual’s gross income. Additional contributions are possible. | Contribution dependent on age, sex, individual health risk and chosen services. |
Access to health care system | Medical care of authorised physicians, authorized dentists and if possible inpatient treatment in the nearest hospital. | Free selection of physicians, dentists and hospitals. |
Settlement of medical services | Billing of the medical services directly to the health insurance company. | Billing of the medical services directly to the patients, who apply afterwards for reimbursement from the private health insurance company. |
Restrictions for pharmacotherapy and reimbursement (German Social Code, Book Five) | Limitation of budgets regarding patented medication. Prescription of generic drugs, if possible. | No restrictions. |