The healthcare systems in Spain and Germany are both based on universal coverage, but there are significant differences in their structure and operation.
Statutory health insurance in Germany
The German healthcare system is a dual system. This means that there are two types of health insurance: statutory health insurance (GKV) and private health insurance (PKV). SHI is compulsory for all employees whose gross income is below a certain limit, the so-called compulsory insurance limit. All others can choose whether they want to take out statutory or private insurance.
Contributions to statutory health insurance are income-related and are usually paid half by the employee and half by the employer. SHI provides comprehensive cover, including outpatient and inpatient treatment, rehabilitation, sick pay and more.
Statutory health insurance in Spain
In contrast, the Spanish healthcare system is a standardised system based on a state-financed general health insurance scheme, the Seguridad Social. It is financed by social security contributions, which are paid by the employer and the employee, and by general taxes.
Seguridad Social offers comprehensive cover and includes almost all medical services. This includes outpatient and inpatient treatment, check-ups, emergency care and more. However, there are some services, such as dental treatment, which are only covered to a limited extent and for which you can take out private insurance.
Main differences
The biggest difference between the two systems lies in their structure: while Germany has a dual system with a choice between statutory and private insurance, the Spanish system is a unitary system based almost exclusively on the state-funded Seguridad Social.
There are also differences in financing. In Germany, contributions are based on income and are paid half by the employee and half by the employer, while in Spain social security contributions and general taxes contribute to financing.
Another difference lies in the benefits covered. While statutory health insurance in Germany offers comprehensive cover, including sick pay, certain services in Spain, such as dental treatment, are only covered to a limited extent.
Despite these differences, both systems have the common goal of guaranteeing universal and comprehensive healthcare for all citizens.
Service provision
In Germany, healthcare services are mainly provided by private providers, such as doctors in individual or group practices, hospitals and pharmacies. The SHI concludes contracts with these service providers that regulate the exact conditions of service provision.
In the Spanish healthcare system, on the other hand, many service providers are directly integrated into the state healthcare system. For example, many doctors and hospitals are directly part of the Seguridad Social and are paid by it. There is also a stronger regional component, as the individual autonomous communities in Spain have a considerable influence on healthcare provision and also have some of the funds at their disposal.
Private insurance
Although the German healthcare system allows a choice between statutory and private health insurance, statutory health insurance has the largest proportion of insured persons. Private health insurance is mainly used as supplementary insurance or as an alternative insurance for certain population groups, such as the self-employed or high-earning employees who are above the compulsory insurance threshold.
In Spain, the role of private health insurance is smaller. As the Seguridad Social covers almost all medical services, private insurance is mainly used to cover services that are not covered or only covered to a limited extent, such as dental treatment, or to improve patient comfort and choice.
Although there are significant differences in the structure and operation of statutory health insurance in Spain and Germany, they share the common goal of ensuring universal healthcare for all citizens. Statutory and private health insurers in both countries complement each other to ensure comprehensive and high-quality healthcare.
