“Flattening the curve”: How Germany’s healthcare system has enabled a robust response to Covid-19

Updated: Apr 20

Germany is widely considered by global media as a shining example of how a nation ought to handle the outbreak of Covid-19. Now set to be the European pioneer in easing national lockdown measures, the country has shown itself as uniquely capable in combating a global pandemic. How, exactly, does Germany’s healthcare system work, and how has its makeup prevented the nation from collapsing under the strain of the Coronavirus?

“Flattening the curve” - aiming to slow the virus’ spread so that fewer people need to seek treatment within a given time frame - has been the main tactic of European countries in order to avoid their healthcare systems becoming overwhelmed, and explains why so many have implemented “social distancing” guidelines.

The German healthcare system is the oldest in Europe, dating back to the 1880s. Today, the country has gained an internationally positive reputation for healthcare, ranking 12th in the latest Euro Health Consumer Index. The 2018 report stated that “Germany has traditionally had what could be described as the most restriction-free and consumer-oriented healthcare system in Europe”.

Healthcare in Germany is based on a dual public-private system, funded by a combination of government subsidies and statutory contributions. It is a legal requirement to be covered by either sector. One of the main reasons why Germany seems to be ahead in the race against Covid-19 is the country’s generous public spending, assigning 11.1% of its annual GDP to healthcare expenditure, well above the EU average of 9.9%. This translates to just over 4,000 euros per inhabitant per year, making Germany one of the biggest spenders on healthcare in Europe.

As a result, hospitals are well-equipped. Germany has more hospital beds per person than anywhere else in Europe: 8.1 beds per 1000 inhabitants, compared with 2.6 in the UK, enabling an effective response to the crisis. Indeed, German hospitals have even possessed the capacity to treat patients from France and Italy, while other nations seem to be under increasing pressure to make ends meet.

To supplement government spending, an annual social insurance contribution of 14.6%, levied on income, is split equally between employee and employer. Gesetzliche Krankenversicherung (public health insurance) is therefore free for all, covering primary care, hospital care and basic dental treatment. This national coverage enables average healthcare costs to be kept to a minimum, a primary reason that the system has amassed such a positive global reputation. Higher-income workers can also take out private Krankenversicherung (private health insurance), which covers a much wider range of medical and dental treatments, to replace or top up the standard health coverage.

Germany’s federal political system also appears to have contributed. The German system is decentralised, meaning that instead of one central authority providing public health services, its 16 federal states are individually responsible for their healthcare systems. In terms of Covid-19, the lack of central legislation has seen both advantages and disadvantages for Germany.

It was initially difficult for the country to move in sync in applying lockdown measures, with chancellor Angela Merkel only able to make social-distancing recommendations that federal states were free to either adopt or ignore.

However, this regional autonomy has ultimately enabled early, widespread testing to be conducted nationwide and it is precisely this high testing which has proven to be key to Germany’s success in “flattening the curve”, in other words, slowing the virus’ spread.

Through the federal system, the work of different laboratories is better coordinated, as each state is equipped with an ample quantity of doctor’s practices and hospitals, allowing for the establishment of a remarkable number of testing centres. Consequently, hundreds of health officials are currently overseeing the pandemic response across the 16 states, rather than relying on one, central response from the national health ministry.

As a result, the autonomy of each state allows for a more accurate, localised read of confirmed cases and the wait for approval from a national board is not necessary. Each state can tailor its response to the outbreak accordingly. In Bavaria, for example, the region with the highest death toll and the first to be put into lockdown, teachers and other furloughed workers have been recruited as volunteers in health offices, manning hotlines for infected citizens, as reported by the Süddeutsche Zeitung.

While the coming weeks will prove testing for Germany as each state decides to what extent restrictions should be eased, one thing is certain for virologists: Germany’s continually funded, flexible healthcare system is worthy of praise for its management of the outbreak thus far.

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