Population perspectives on health system performance: preliminary findings from Germany
M Nagase, S Carai, R WeigelAbstract
Background
In Germany, despite near-universal insurance, gaps may remain between available healthcare services and people’s needs. Population-level data on people’s health system experiences are limited. The People’s Voice Survey was conducted to provide evidence on access, quality, and confidence in the health system.
Methods
The survey was translated and adapted for Germany. Data collection took place over two weeks in December 2024 using an online panel designed to be nationally representative. The analysis included adults aged 18 years above (N = 2,558). Weighting accounted for age, gender, education, and federal state. Stata was used for all analyses.
Results
Almost all respondents (99%) reported having health insurance, with 89% covered by statutory health insurance. About 74% had a usual healthcare provider, most often a doctor’s office (89%). Overall, 61% rated their last healthcare visit as very good or excellent. About 42% reported that the health system had worsened over the past two years, compared with 11% reporting improvement. 64% indicated that major changes are needed, whereas 15% felt only minor changes are necessary.
Conclusions
Germany achieves near-universal coverage, but important gaps remain in continuity of care, healthcare needs and health system performance. The relatively low proportion reporting a usual source of care and evidence of unmet need suggest misalignment between services and population needs. Widespread dissatisfaction may point to declining confidence and highlights the need for structural reforms to better align health system delivery with people’s expectations and needs.