Navigating patients’ Health-Related Social Needs (HRSNs) can be a challenge for health systems around the globe. Hospitals abroad that are rooted in Adventism, like Germany’s Waldfriede Hospital, are also grappling with how to tackle HRSNs like geography and workforce shortages. To compare some of the largest challenges facing other industrialized nations, AHPA had the opportunity to speak firsthand with clinicians working in Germany to get their perspectives. Keep reading to learn more about policy challenges German health systems have in common with the U.S. and how they are thinking about solving them.

The German system operates as a universal multi-payer health care system, so hospitals like Waldfriede don’t have much uncompensated care. Germans are required by law to have health insurance, with both Statutory Health Insurance (SHI) available for people who earn less than a certain income, and private health insurance available for those who choose to purchase their own. All workers contribute about 7.5% of their salary into a public health insurance pool, which employers match. Unemployed individuals contribute to SHI in proportion to their unemployment benefits. The approach is rooted in Germany’s “Principle of Solidarity” which fosters an “all for one, and one for all” approach. The system imposes strict limits on out-of-pocket costs, which greatly reduces the number of surprise medical bills. The maximum copay for prescription medications is about $10.

Like in the U.S., delivering medical care in Germany’s rural areas is a challenge. According to a recent German study, approximately 11,000 of their family physician practices will be unoccupied by 2035, worsening access for the roughly 40% of rural districts already facing physician shortages. The country is looking to invest in and leverage new technologies like telehealth and remote monitoring to expand access. Germany is notorious for having poor internet connectivity; as many as 38% of Germans struggle with internet delays.

Germany’s policymakers are also trying to manage health care costs for a rapidly-booming senior population. Under the SHI system, seniors receive coverage for essential medical treatments, including doctor visits, hospitalization, and medications. However, the rapid growth of the aging German population is putting a strain on resources and the accessibility of care and senior living facilities. In response, the German federal government set up the Concerted Action for Nursing (CAN) to meet the challenges caused by demographic changes in nursing and long-term care. Stakeholders involved in the group agreed on binding goals and measures to improve the working conditions of nursing professionals, enhance nursing training, and improve the remuneration of professional caregivers.

An aging population, continuing recruitment and retainment problems, and the post-COVID-19 exhaustion are exacerbating existing workforce shortages in Germany, just like it is for us in the United States. Reports estimate that by 2035, more than a third of all health care jobs in Germany could be unfilled. The outlook for the U.S. is similar; the nation is facing a shortage of up to 124,000 physicians by 2033 and will need to hire at least 200,000 nurses per year to meet increased demand and replace retiring nurses. In recent years, Germany has looked at reforming its immigration law to allow for more skilled labor to enter the country. Via the CAN initiative, Germany is making it easier to recruit nursing staff from abroad with shorter visa procedures; language courses; and close cooperation with the health care sector. While Germany pulls in talent from around the world, it does have the advantage of being able to attract from neighboring European Union (EU) countries with fewer regulatory hurdles.