Germany

  • Summary
  • Healthcare
    system
  • Health
    insurance
  • Facts and figures
  • Medical Tourism
  • Events
  • Related
    Content
  • Industry
    participants

Healthcare system

German healthcare is one of the best, most efficient, most advanced and most available in the world. Germany owes its leading position to the unparalleled level of collaboration between science, resea ...

Health insurance

Since 2009, health insurance has been mandatory for all citizens and permanent residents of Germany (previously, certain populations could choose not to have insurance, though few did so). In Germany, ...

Facts and figures

Capital : Berlin
Population : 82 million
Healthcare expenditure : 4,683.2 US $
No. of doctors : 338129


 
 
 

Medical tourism

Within this section, you will find published information on medical tourism numbers, our estimate of inbound and outbound medical tourism, and IMTJ news and external news that provide estimates of med ...
 
Inbound patients : 115,000
Outbound patients : 100,000
 

Industry participants

Find an organisation

Events

IMTJ Medical Travel Summit 2019

02 December, 2019 to 03 December, 2019

Berlin

The IMTJ Summit is a high-level event aimed at senior decision makers involved in the medical tourism and international patient market.

IMTJ Medical Travel Awards 2019

03 December, 2019

Berlin

The IMTJ Medical Travel Awards 2019 celebrates outstanding achievement in the medical travel, medical tourism and health tourism industry worldwide. ENTRY DEADLINE 31 MAY.

view all

Healthcare system

Germany flag

German healthcare is one of the best, most efficient, most advanced and most available in the world. Germany owes its leading position to the unparalleled level of collaboration between science, research, industry and medicine. Germany invests more financial resources in the development of its medicine than any other country in the EU.

Germany is leading and showcasing more advanced results than others in the treatment of cancer, blood disorders and diseases of the cardiovascular system, transplantations, infertility, and epileptic disorders. In addition, their hospitals use more organic pharmacies and medicine.

States own most university hospitals, while municipalities play a role in public health activities and own about half of hospital beds. However, the various levels of government have virtually no role in the direct delivery of health care.

Not-for-profit public hospitals make up about half of all beds, while private not-for-profits account for about a third. The number of private, for-profit hospitals has been growing in recent years. The country has 2000 hospitals, which treat 18.5 million people annually.

Health insurance

Health Insurance - Compulsory

Since 2009, health insurance has been mandatory for all citizens and permanent residents of Germany (previously, certain populations could choose not to have insurance, though few did so).

In Germany, health insurance is mandatory. Everyone living in Germany must be insured for at least hospital and outpatient medical treatment. For anyone planning to spend six months or more in Germany, or move there in a job-related capacity, health insurance is mandatory.

A universal multi-payer healthcare system is in place. Those in lower-income brackets benefit from compulsory cover, via one of many sickness funds. People who receive higher incomes may opt in to this system or can choose private insurance instead. Alternatively, a combination of the two is available.

The Federal Joint Committee has wide-ranging regulatory power to determine the services to be covered by sickness funds and to set quality measures for providers.

Most German residents are members of the government health system. Benefits include in-patient (hospital) care in a ward at nearest hospital, outpatient care with registered doctors and basic dental care. Non-working dependents resident in Germany are included in the insurance at no additional cost.

Insurance is provided by competing, not-for-profit, nongovernmental health insurance funds (sickness funds); there were 134 as of January 2013) in the statutory health insurance scheme (SHI), or by voluntary substitutive private health insurance (PHI). A large degree of regulation is delegated to self-governing associations of the sickness funds and the provider associations.

The health insurance funds adhere to established government regulations on what they offer.

AOK is the largest statutory health insurer in Germany, ensuring about 24 million people under the 13 regional branches, making it responsible for the health of about a third of the German population. Other leading statutory insurers include KKH-Allianz, which insurers about two million people with 114 service centers throughout Germany, and Techniker Krankenkasse.

Cover is universal for all legal residents. All employed citizens (and other groups such as pensioners) earning less than €452,200 per year are mandatorily covered by SHI, and their dependents are covered free of charge. Individuals whose gross wages exceed the threshold, civil servants, and the self-employed can choose either to remain in the publicly financed scheme on a voluntary basis (and 75% of them do) or to purchase substitutive private health insurance.

86 percent of the population has primary cover through a sickness fund and 11 percent through substitutive private health insurance. The remainder (e.g. soldiers and policemen) is covered under special programmes. Undocumented immigrants are covered by social security in case of acute illness and pain, as well as pregnancy and childbirth.

Sickness funds can offer a range of deductibles and no-claims bonuses. Preventive services do not count toward the deductible. Contracted physicians are not allowed to charge above the fee schedule for services in the SHI benefit catalogue. However, a list of individual health services outside the comprehensive range of SHI cover may be offered to patients paying out-of-pocket.

Sickness funds are autonomous, not-for-profit, nongovernmental bodies funded by compulsory contributions levied as a percentage of gross wages up to a ceiling. Since 2009, a uniform contribution rate has been set by the government (and has been set in federal law since 2011. Sickness funds’ contributions are centrally pooled and then reallocated to each sickness fund based on a risk-adjusted capitation formula, taking into account age, sex, and morbidity from 80 chronic and/or serious illnesses. Since 2009, sickness funds have been able to charge the insured person an additional nominal premium if a sickness fund’s revenue is insufficient (or to reimburse patients in the case of surplus revenue).

Facts and figures

General InformationSource

Capital : Berlin
Population : 82 million
Main languages spoken : German
Main religion : Christianity
International dialling code : +49
Internet domain : .de
Gross National income (GNI) per capita : 44540 US $
WHO 2015

Tourism data

International inbound tourists : 35555000 arrivals
World Bank 2015
International outbound tourists : 83737000 departures
World Bank 2015

Population profile

Life expectancy (male) : 83.1 years
OECD / WHO 2015
Life expectancy (female) : 83.1 years
OECD / WHO 2015
Population over 65 : 17254.694 Thousand persons
UN 2015
Population over 80 : 4617.905 Thousand persons
UN 2015

Healthcare workforce

Physicians (total) : 338129 persons
OECD 2016
Physicians (per 1,000 population) : 4.14 per 1,000 population
OECD 2016
General Medical Practitioners (total) : 139245 persons
OECD 2016
General Medical Practitioners (per 1,000 population) : 1.7 per 1,000 population
OECD 2016
Specialist Medical Practitioners (total) : 198884 persons
OECD 2016
Specialist Medical Practitioners (per 1,000 population) : 2.43 per 1,000 population
OECD 2016
Nurses (total) : 1090000 persons
OECD 2016
Nurses (per 1,000 population) : 11.49 per 1,000 population
OECD 2016
Dentists (total) : 69863 persons
OECD 2016
Dentists (per 1,000 population) : 0.81 per 1,000 population
OECD 2016

Healthcare expenditure

Healthcare expenditure per capita : 4,683.2 US $
WHO 2012
Healthcare expenditure as % of GDP : 11.3 percentage
WHO 2015
Government expenditure on health as % of total government expenditure : 19.3 percentage
WHO 2015
Per capita government expenditure on health : 3556 US $
WHO 2015
Private expenditure on health as a percentage of total expenditure on health : 23.3 percentage
WHO 2015

Healthcare provision

All hospitals : 3108 hospitals
OECD 2016
Public hospitals : 806 hospitals
OECD 2016
Private hospitals : 1323 hospitals
OECD 2016
Total hospital beds : 664364 beds
OECD 2016
No of hospital beds (per 1,000 population) : 8.13 beds
OECD 2016
CT scanners (per 1 million population) : 35.09 scanners
OECD 2016
MRI scanners (per 1 million population) : 33.63 scanners
OECD 2016
PET scanners (per 1 million population) : No data available
OECD

Healthcare activity

Hospital discharges : 20858128 patients
OECD 2016
Coronary angioplasty (per 100,000) : 393.2 procedures
OECD 2016
Hip replacement (per 100,000) : 299.3 procedures
OECD 2016
Knee replacement (per 100,000) : 205.8 procedures
OECD 2016
Cataract surgery (per 100,000) : 1027.7 procedures
OECD 2016
Hospitals - Average length of stay : 9 days
OECD 2016
Hospitals - Occupancy : 79.3 percentage
OECD 2016

Health profile

Breast cancer: Female mortality rate (per 100,000) : 28.8 deaths
OECD 2016
Prostate cancer: Male mortality rate (per 100,000) : 34.5 deaths
OECD 2016
Ischemic heart disease: Male mortality rate (per 100,000) : 146 deaths
OECD 2016
Ischemic heart disease: Female mortality rate (per 100,000) : 76.4 deaths
OECD 2016
Deaths due to HIV/AIDS (per 100 000 population) : 0.4 deaths
OECD 2016
Prevalence of Obesity (BMI >30) : 23.6 percentage
OECD 2017

Cosmetic surgery

Number of plastic surgeons : 1152 surgeons
ISAPS 2016
Total cosmetic: All procedures : 730437 procedures
ISAPS 2016
Total cosmetic: Surgical procedures : 336396 procedures
ISAPS 2016
Breast procedures : 102113 procedures
ISAPS 2016
Face and head procedures : 140797 procedures
ISAPS 2016
Total cosmetic: Non-surgical procedures : 394042 procedures
ISAPS 2016

Obesity surgery

Number of operations performed : 7126 procedures
Metabolic / Bariatric Surgery Worldwide 2014
Number of metabolic/bariatric surgeons : 60 surgeons
Metabolic / Bariatric Surgery Worldwide 2011

Medical tourism

Introduction

Within this section, you will find published information on medical tourism numbers, our estimate of inbound and outbound medical tourism, and IMTJ news and external news that provide estimates of medical tourism activity within Germany.

The IMTJ estimates below are based on the information that we gather and our view of the validity and credibility of this data. It is our view of what the real number of medical travellers is likely to be i.e. the number of patients who specifically travel for the primary purpose of healthcare. "No data available" means that there is insufficient information to be able to make any kind of realistic estimate.

Inbound medical tourism

The biggest source of patients to Germany is Russia, followed by the Middle East; particularly the UAE and Saudi Arabia; and other Eastern European countries. There is also strong interest in medical tourism from some European markets, including the Netherlands, UK and Austria. And there is a small amount of business from the USA and Israel.

Jens Juszczak at the University of Bonn Rhein Sieg states that Germany gets twice as many patients from the CIS and the Baltic States as from the Middle East, and that the number from the area has grown seven fold over recent years. But the mixing of tourists and medical tourists in the numbers makes it hard to know which countries are the main providers of medical tourists rather than tourists who needed treatment while in Germany.

It is almost certain that numbers to Germany from Russia have fallen, but numbers from various Middle East countries have grown to fill the gap. The country attracts a significant number of Arab patients from the Middle East, mainly from the UAE, Saudi Arabia, Kuwait, Qatar and Oman.

The most requested specialties are orthopaedics, internal medicine, cardiology and cancer treatment.

Berlin is an increasingly popular medical tourism destination. With more than 130 clinics, 70 rehab facilities, and around 140,000 hotel beds, it is an excellent location for medicine and research.

Major clinics such as the German Heart Center, the Chartite – Universitätsmedizin Berlin, and the municipal hospital group Vivantes have added specific services  to suit the needs of international patients.These include multilingual contact persons, interculturally-trained staff, and special comfort areas.

International patients are attractive to the clinics for a number of reasons. They generate additional income, use spare capacity, usually choose higher-quality accommodations, take advantage of additional services, and stay longer on site than is the case, for example, with city travelers. By connecting providers and creating holistic treatment structures, the German capital region can benefit from medical tourism.

2018 data

255,000 people from 177 countries receive medical treatment in Germany. But that number includes tourists so should be downgraded to around 115,000. Annually, Germany  receives more than 1.2 million euros from medical tourism.

In March this year, Minister of Health Dr Basel Al-Sabah disclosed the number of approvals for overseas treatment after they were approved by the specialised committees of hospitals and medical centres during the first half of 2018. The figure was 3,900 cases, an average of around 650 cases per month. Most Kuwait nationals received treatment in the UK, the United States and Germany.

2017 data

There have been reports of the treatment of 224,000 foreign patients in Germany per year; these numbers include foreign tourists, business travellers and expatriates who have been injured or fallen sick. Bonn-Rhein-Sieg University estimates that 45% of the total number of foreign patients (around 100,000) went to Germany explicitly for treatment. The German National Tourist Board has published estimates of 77,000 foreign patients. Premier Healthcare Germany claims to have handled 100,000 patients from the Gulf region over an undefined period. Berlin claims to attract around 10,000 medical tourists per annum. Germany’s second largest city Hamburg attracts 30,000 tourists from the Gulf region and is becoming a medical tourism destination for them. Arab patients make up more than 50% of international admissions at Hamburg’s largest hospital.

According to a study by the University of Munich, wellness tourism in Bavaria is an important economic factor and brings in annual revenue of 4.5 billion euros. The study claims that spas account for 58% of local tourism revenue.

In 2016, Germany was the most popular destination for medical tourists coming from the United Arab Emirates with (28.6%) patients seeking treatment. However, in 2017, Germany came at a second place with 21.9% followed by UK at 21.4%, with Dh4.24 million being spent per patient. 

In 2017, around 247,500 patients from 177 countries were hospitalised or required ambulatory care netting the country around €1.2 billion (US$1.4 billion).

The numbers are down around 2% on the previous year thanks to what the university calls a "massive collapse" of patients from the Gulf as the states rethink the hundreds of millions of Euros they provide for treatment abroad every year.

Across Germany, the number of patients from Kuwait is down 62%, from Saudi Arabia has declined 36%, and from Oman is off by 28%.

Particularly affected are the states of Berlin and Baden-Württemberg which have seen a 14% and 9% decline in medical tourism spending respectively. In those two federal states medical tourists from the Gulf are down 79% and 70%.

2016 data

Abu Dhabi Health Authority sends 3,000 patients a year to foreign countries, 33% of these go to Germany.

2014/15 data

In 2015, medical tourism in Germany increased by just 1.4%. The number of Russian patients travelling to Germany fell in by 32.4%, while numbers from the Saudi Arabia Kuwait and other Gulf states improved.

The international unit it Klinikum Stuttgart used to receive around 5,500 medical tourists annually, but closed in 2016 due to financial problems. In 2014, a total loss of 24.563 million euros was generated, and 2015 saw losses of 27.6 million euros. The hospital still treats international patients.

Numbers of Russian patients are reported as dropping in 2014. In 2015 the German medical tourism industry recorded a decline of 32.4 % with respect to Russian patients. The reason for the decrease was most likely the EU's economic actions against Russia in late July 2014 in the wake of the Crimean annexation under President Vladimir Putin.

In 2014 Germany attracted over 10,000 medical tourists from Saudi Arabia. In 2015 the patients travelling to Germany from the Gulf recorded growth of 17%, mainly driven by Saudi Arabia (34% of the Gulf figure and Kuwait (19% of the Gulf figure). It is expected that medical tourism in Germany will rely more on patients from the Gulf.

According to Health Capital, up to 21,000 international patients, often travelling with companions, are treated in Berlin every year. They generate an annual turnover of 100-150 million euros.  The revenues of medical facilities are approximately 80-102 million euros, the turnover of the hotel industry amounts to 4-11 million euros, and that of commerce amounts to 10-15 million euros.

2013 data

According to the German National Tourism Board (GNTB), the number of medical tourists to Germany increased from 172,341 in 2009 to 242,784 in 2013. But it is very unclear if these are international patients including medical tourists, or medical plus health and wellness tourists.

Estimates of revenue from medical treatment per patient range from €9,000 to €12,000 per patient. Juszczak estimates that German hospitals earned 1.2 billion euros from overseas patients in 2013.

The importance of Russians to the German medical tourism business is that the largest group of patients in 2013 came from Russia, almost 11,000 of them, according to Germany's Federal Statistical Office. A further 3,000 from other former Soviet republics in the CIS were also treated in Germany.

2012 data

According to exit visa statistics 1,000 Qataris went to Germany for medical treatment in 2012.

In late 2012, an Armenian publication said that an unnamed source of international research shows Germany and Israel are the primary choice for those travelling to foreign countries for treatment from Russia and CIS states. The treatment in Germany is almost twice as expensive in comparison with that in Israel. It reported that in 2012 more than 26,000 people from CIS countries underwent treatment in German hospitals.

German National Tourist Board forecasts that health and medical tourism will grow strongly over the coming decades, due to changes in lifestyles and demographics. A 2012 survey of 300 travel experts from 12 countries gave their views. Nearly 40% of them expect growth over the next 20 years in health-related travel activities.

2010 data

According to the World Travel Monitor, 341,000 Europeans visited Germany for health reasons in 2010, compared to 157,000 in 2009. It is difficult to split health and medical tourism in these early numbers. The most common area in Germany for wellness medical tourism is Bavaria, where annually 4.5 billion euros is spent on health tourism.

Outbound medical tourism

According to research by the Wineg-Institute of the Techniker health insurance (TK), the top four destinations for insurance funded spa and dental treatment abroad are Italy, Poland, Czech Republic and Hungary.

2018 data

Russia topped the list by sending 5.1 million visitors to Turkey between January and October, followed by Germany (3.6 million) and Britain (1.9 million).

Medsi centers in Russia handle nearly eight million medical cases a year – only five percent of which involve foreigners, but their numbers are on the rise. Most patients come from China, and are interested in in vitro fertilization (IVF) and orthopedics. Others come from Germany, Bulgaria ‘and other countries’.

2017 data

The ministry said a total of 1,307 Saudi patients, constituting more than 54%, were treated in the United States while 766 were treated in Germany, 236 in Britain and 92 in China.

It said the cost of treatment was the highest in America reaching about SR1.54 million per individual patient while in Britain it was about SR361,000.

2012 data

According to the Turkish Department of Health Tourism 21,084 patients from the country went to Turkey as medical tourists in 2012.

2011 data

Holidays at wellness and spa resorts rose by 30 % since 2006. By contrast, medical travel has declined, according to the findings of the World Travel Monitor, commissioned by ITB Berlin, over the same period the number of cure, rehabilitation and hospital stays abroad has fallen by 18%.

2007 data

According to insurer TK, based on a survey of what members did in 2007, it estimated between 167,000 and 220,000 went overseas for treatment-not counting spa treatment and dental treatment where people did not claim from insurers. Our view is that this figure is far too high and out of date.

IMTJ estimates

Inbound medical tourists : 115,000
Outbound medical tourists : 100,000

Events

IMTJ Medical Travel Summit 2019

02 December, 2019 to 03 December, 2019

Berlin

The IMTJ Summit is a high-level event aimed at senior decision makers involved in the medical tourism and international patient market.

IMTJ Medical Travel Awards 2019

03 December, 2019

Berlin

The IMTJ Medical Travel Awards 2019 celebrates outstanding achievement in the medical travel, medical tourism and health tourism industry worldwide. ENTRY DEADLINE 31 MAY.

 
 

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Industry participants

Find hospitals and clinics, agents and facilitators, services and other organisations operating in the medical travel industry that are based in Germany.

Find an organisation

Featured organisations

visitBerlin

Tourism board in Berlin

Klinikum Medical Link

Medical travel agency in Bamberg

Klinikum Medical Link is a network of international surgeons and doctors who offer outstanding quality health care in all of their private and public hospitals across Europe.

Premier Healthcare Germany GmbH

Medical travel agency in Hamburg

Based in Hamburg, Premier Healthcare Germany is an independent medical travel agency devoted to helping people from all over the world to access world class medical care in German hospitals and clinics. Specialising in organising surgical interventions, medical check-ups and rehabilitation programmes, PHG has a particular expertise in orthopaedics, spinal surgery, heart surgery, vascular surgery, obesity surgery and gastroenterology. A personalised approach means that all individual requests and requirements are welcomed, however.

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UPCOMING EVENTS

Fertility Forum 2019

01 November, 2019

London

IMTJ Medical Travel Summit 2019

02 December, 2019 to 03 December, 2019

Berlin

IMTJ Medical Travel Awards 2019

03 December, 2019

Berlin