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German healthcare system

Germany has a universal multi-payer health care system with two main types of health insurance: “Statutory Health Insurance” (Gesetzliche Krankenversicherung) known as sickness funds and “Private Health Insurance” (Private Krankenversicherung). Health insurance is compulsory for the whole population in Germany. Salaried workers and employees below the relatively high income threshold of almost 50,000 Euros per year are automatically enrolled into one of currently around 130 public non-profit “sickness funds” at common rates for all members, and is paid for with joint employer-employee contributions. Provider payment is negotiated in complex corporatist social bargaining among specified self-governed bodies (e.g. physicians’ associations) at the level of federal states (Länder). The sickness funds are mandated to provide a unique and broad benefit package and cannot refuse membership or otherwise discriminate on an actuarial basis. Social welfare beneficiaries are also enrolled in statutory health insurance, and municipalities pay contributions on behalf of them. Besides the “Statutory Health Insurance” (Gesetzliche Krankenversicherung) covering the vast majority of residents, the better off with a yearly income above almost €50,000 (USD 44,000), students and civil servants for complementary coverage can opt for private health insurance (about 11 % of the population). Most civil servants benefit from a tax-funded government employee benefit scheme covering a percentage of the costs, and cover the rest of the costs with a private insurance contract. Recently, private insurers provide various types of supplementary coverage as an add upon of the SHI benefit package (e.g. for glasses, coverage abroad and additional dental care or more sophisticated dentures). The health economics of Germany sector was about US$368.78 billion (€287.3 billion) in 2010, equivalent to 11.6 percent of gross domestic product (GDP) this year and about US$4,505 (€3,510) per capita. According to the World Health Organization, Germany’s health care system was 77% government-funded and 23% privately funded as of 2004. In 2004 Germany ranked thirtieth in the world in life expectancy (78 years for men). It had a very low infant mortality rate (4.7 per 1,000 live births), and it was tied for eighth place in the number of practicing physicians, at 3.3 per 1,000 persons. In 2001 total spending on health amounted to 10.8 percent of gross domestic product.