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Germany’s healthcare system is one of the most heated topics at healthcare conferences, panels, and webinars. People tend to either praise it or criticize it sharply, leaving no space for the middle ground. This polarization is reflected in the policy paper “Positionspapier Primärarztsystem”, which outlines key proposals and perspectives on how Germany’s healthcare system could be structured in the years ahead.
By many international benchmarks, the system performs well. According to the Foundation for Research on Equal Opportunity, Germany ranked third in the 2024 World Index of Healthcare Innovation. For decades, German healthcare has been known for broad coverage, strong clinical expertise, and reliable access to care. However, beneath this apparent stability, structural pressures have been becoming more and more relevant. We have already covered many aspects of the rising issues, such as an aging population, rising prevalence of chronic disease, workforce shortages, and increasing costs, which are pushing the system closer to its limits. At the same time, patient expectations are changing, shaped by digital services that offer speed, transparency, and personalization in nearly every other aspect of life.
At the same time, patient expectations are shifting. Digital services in everyday life offer speed, transparency, and personalization, and healthcare is increasingly being measured against these standards. Yet Germany lags behind in this area. In 2025, Bitkom ranks the country 14th out of 27 EU member states in overall digitalization, creating a striking contrast: one of Europe’s most effective healthcare systems is falling behind digitally.
What once could be addressed through incremental reforms now demands more fundamental rethinking. The question is no longer whether Germany’s healthcare system needs to change, but how quickly it can adapt without compromising quality, equity, or trust. Issues such as the role of primary care, digital access, data interoperability, and prevention are now central to the debate. The decisions made in the coming years will determine whether the system remains sustainable or becomes increasingly reactive under growing demand.
Germany’s healthcare system is traditionally anchored in strong primary care, with general practitioners (Hausärzte) acting as the first point of contact for most patients. This model is designed to ensure continuity, early diagnosis, and appropriate referrals into specialist or hospital care. Statutory health insurance guarantees broad access, and patients retain a high degree of freedom in choosing providers.
At the same time, the system is marked by structural fragmentation. Care delivery is split across multiple sectors that often operate independently:
Information flow between these sectors remains limited. Many processes are still paper-heavy, and digital adoption varies widely by region and provider. As a result, care coordination often depends on manual effort rather than shared data or integrated systems.
What still works well is Germany’s strong clinical expertise and reliable acute care. However, growing administrative burden, workforce shortages, and coordination gaps are increasingly visible, signaling that the current structure is under mounting pressure.
Primary care is seen as the cornerstone of a sustainable German healthcare system. A more structured primary care or gatekeeper model aims to strengthen the role of general practitioners as coordinators of care, ensuring patients receive the right treatment at the right time, and in the right setting.
A strong primary care system supports the system on multiple levels:
International experience shows that countries with robust primary care tend to achieve better outcomes at lower cost. However, Germany cannot simply copy other models. Its healthcare structure, funding mechanisms, and patient expectations are distinct.
Critically, reforming primary care without digital support would be risky. Without interoperable data, digital access, and modern coordination tools, gatekeeping could create bottlenecks instead of improving care. Primary care reform and digital infrastructure must evolve together.
In the future German healthcare system, digital access should no longer be an optional add-on or a fallback when in-person care is unavailable. Instead, it can become the first structured entry point into the system. A digital-first approach does not replace physicians, but helps ensure that human care is used where it adds the most value.
Digital front doors can support healthcare systems in several ways:
This approach helps reduce unnecessary in-person visits, which are a major source of strain in today’s system. Minor issues can be resolved digitally, while complex cases are escalated with better context and preparation.
The benefits extend across the system. Patients gain faster access and clearer guidance, providers can focus on medical decision-making instead of administrative sorting, and system capacity is used more efficiently. When implemented responsibly, digital-first access becomes an enabler of better care, not a barrier.
A future-ready German healthcare system is built around a seamless, guided patient journey. Digital tools do not replace care, they structure it, reduce friction, and support better decisions at every step.
The journey begins before the first appointment. Structured digital intake becomes the standard entry point into care.
This ensures that the right patients reach the right care level from the start.
Primary care remains the anchor of the system, now supported by digital delivery models.
Digital care strengthens primary care capacity instead of overloading it.
When specialist care is needed, referrals become data-driven and coordinated.
This improves access while protecting scarce specialist resources.
Care no longer ends after a single visit.
The result is a healthcare journey that is connected, transparent, and designed around long-term health rather than isolated encounters.
If there is one lesson from digital healthcare initiatives across Europe, it is this: without interoperability, even the best digital tools fail to scale. Digital healthcare does not break down because of missing apps or insufficient technology, but because data does not flow. When patient information remains trapped in isolated systems, care becomes fragmented, inefficient, and error-prone.
Interoperability must therefore be treated as infrastructure, not innovation. Electronic patient records (ePA), standardized APIs, and shared data models are the foundation that allows digital services to work together across primary care, specialists, hospitals, insurers, and digital health providers. Without this backbone, new solutions simply create new silos, repeating the mistakes of the past in digital form.
To avoid this, Germany must focus on several structural requirements:
Equally important is governance. Digital healthcare cannot scale without trust. Strong data protection, transparent consent models, and clear accountability are essential, but they must be paired with pragmatic implementation. Overly complex regulation slows innovation without improving safety, while unclear rules discourage investment and adoption.
Incentives also matter. Today’s system largely rewards treatment rather than prevention. For digital health to deliver long-term value, reimbursement models must fairly compensate digital, asynchronous, and preventive care, especially in primary care settings.
Finally, innovation will not come from the public sector alone. Private companies play a crucial role in developing scalable platforms, analytics, and user-centric solutions. The goal is not deregulation, but smart guardrails that enable collaboration without monopolies. If Germany gets this balance right, it has a real opportunity to remain competitive and build a healthcare system that is both digitally advanced and socially sustainable.
The future of German healthcare will not be defined by a single reform or technology. It will be shaped by a series of coordinated decisions that determine how care is accessed, delivered, and connected. Digital-first primary care offers a clear foundation, enabling better navigation, earlier intervention, and more efficient use of scarce resources. But technology alone is not enough.
What truly matters is system-wide thinking: aligning incentives, enabling interoperability, and supporting care models that seamlessly combine digital and in-person services. This is exactly where infrastructure plays a critical role. At Thryve, we focus on providing the technical foundation that makes such models possible through a unified health data API that offers:
To move from vision to implementation, strong digital infrastructure is essential.
Book a demo with Thryve to explore how interoperable health data can support the future of care.
Paul Burggraf, co-founder and Chief Science Officer at Thryve, is the brain behind all health analytics at Thryve and drives our research partnerships with the German government and leading healthcare institutions. As an economical engineer turned strategy consultant, prior to Thryve, he built the foundational forecasting models for multi-billion investments of big utilities using complex system dynamics. Besides applying model analytics and analytical research to health sensors, he’s a guest lecturer at the Zurich University of Applied Sciences in the Life Science Master „Modelling of Complex Systems“
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