2021: Health expenditure of 465.9 billion euros (first health market)

The healthcare system (the primary healthcare market) in Germany is becoming increasingly expensive, and government transfer payments are rising: €81.4 billion of current healthcare expenditure in Germany was financed through government transfers and subsidies alone in 2021. According to the Federal Statistical Office (Destatis), this was 18.8%, or €12.9 billion, more than in 2020. The share of government subsidies and transfers thus rose by 1.6 percentage points compared to the previous year, to 17.5% of current healthcare expenditure of €465.9 billion.

The increase in government transfers and subsidies, which include the annual federal subsidy to the Health Fund as well as subsidies from public employers, was also due to direct federal subsidies to combat the pandemic in the second year of the coronavirus pandemic. As a direct federal subsidy, the federal government (re-)financed, among other things, €17.2 billion through the Health Fund for compensation payments to hospitals, protective masks under the Coronavirus Protective Mask Ordinance, testing under the Coronavirus Testing Ordinance, and expenses in vaccination centers in 2021. In addition to the direct federal subsidy, the federal government paid €5.0 billion for further measures to combat the pandemic as part of a supplementary federal subsidy.

The federal government subsidized the central procurement of vaccines with approximately €3.5 billion. In addition, the federal government reimbursed €1.0 billion of coronavirus-related social long-term care insurance expenditures. €286.8 billion of ongoing health care expenditures in Germany were financed through social security contributions in 2021.

They continued to be the most important source of financing, accounting for 61.6% of current healthcare expenditure of €465.9 billion. However, this share fell by 1.1 percentage points compared to 2020. Employers financed the largest share of current healthcare expenditure through their social security contributions in 2021, amounting to €113.7 billion (24.4%), followed by employee contributions at €111.7 billion (24.0%).

Other social security contributions (e.g., health insurance contributions paid by pension insurance providers for retirees) covered 13.2% of current health expenditures at €61.4 billion. Another pillar of financing current health expenditures was other domestic revenue (e.g., payments by private households for outpatient and inpatient care), with a volume of €61.9 billion (13.3%). Mandatory premiums, such as those for private comprehensive health insurance, financed €29.8 billion (6.4%) of current health expenditures, while voluntary premiums, such as those for supplementary health insurance, accounted for €5.9 billion (1.3%).

Methodological Notes: The presented results of the financing accounts complement the health expenditure accounts. The financing accounts show how the individual providers of health expenditures finance themselves. Both calculations follow the international concept of the "System of Health Accounts."

For the financing statement, individual revenues are allocated directly or indirectly to expenditure units and financing types using a key. Revenues are considered in relation to expenditures and equated with them. Therefore, the financing statement does not record deficits or surpluses.

The current health expenditure reported here comprises total health expenditure excluding investments. Destatis Press Release No. 136 of January 5 provides information on total health expenditure in Germany in 2021, including an estimate for 2022.

April 2023.