Germany

85% of the population is covered under SHI, with 15% opting to turn towards private insurance. Individuals that earn an annual salary below a pre-specified target, around €50,000, are required to take part in the public healthcare system. Those with salaries above this target, self-employed individuals, and public officers are exempt from this mandatory requirement and can take up private insurance.

Residents of Germany tend to go to the doctor over six times a year. They also have an average hospital stay of nine days, which is much higher than the 5-6 day average stays for Americans. With costs growing, the state continues to find ways to reduce the burden on SHI. In recent years, there has been a greater cost-sharing component for those who are on SHI, with copays for general practitioner visits, specialist visits, dental care, hospital stays, and pharmaceuticals. In 2010, such cost-sharing measures contributed to 2.85% of total SHI revenue.

The German pharmaceutical market is the world’s third largest, after the US and Japan. Pharmaceutical sales in 2010 were estimated at €31bn. Over half of the drugs produced in the nation are exported. Many of the major pharmaceutical manufacturers in Germany are still family-owned or family-controlled. These firms are investing a great deal in research and development.

Recent legislation targeting the pharmaceutical sector is aimed at maintaining the affordability of drugs and promoting competition. Drugs are subjected to "reference prices" unless they possess a clearly demonstrated added benefit. Germany’s market for generic drugs is also the largest in Europe, largely due to regulation that often requires mandatory substitution of generics at pharmacies.