THE GERMAN health care budget for a stable but aging population of 81 million (with an average life expectancy of 76 years) amounts to 9% to 10% of the gross national product. Ninety percent of the population pays for mandatory insurance covering health, unemployment, a retirement pension, and—since 1995—nursing care. Half of the insurance fees are paid by the employee and half are paid by the employer. Private insurance is chosen by 10% of the population.
Of the 320000 physicians in Germany, 6000 are unemployed and 260000 are working, which translates into 1 working physician for every 311 people. Forty percent of the physicians are women and 4% are foreign-born. Physicians are responsible for providing health service and quality control, and for negotiating fees in a self-governance arrangement. The advertising of medical services is illegal, and the federal government sets limits on what can be charged for all medical services.
Gottfried O. H. Naumann. Ophthalmology in Germany. Arch Ophthalmol. 1998;116(10):1366–1368. doi:10.1001/archopht.116.10.1366