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KCE reports vol.40 APPENDICES Physiotherapy 23
4. GERMANY
4.1. BACKGROUND INFORMATION ON THE
HEALTHCARE SYSTEM
4.1.1. Existing Coverage Schemes
Nearly 90% of German residents are insured through the Statutory Health Insurance system (SHI).
Contributions of SHI-members serve to finance sickness funds. The remainder of residents are mostly
insured under private, employment-based schemes. All insured persons receive health benefits.
Suppliers are financed directly by the insurance funds.
4.1.2. Institutional Framework
Both the federal government and Länder are involved with the regulation of health care. Issues of
equity and comprehensiveness and rules for the planning and financing of health services are regulated
at the federal level. The Länder are responsible of the supervision of health services, hospital planning,
health education and promotion. The Gemeinsamer Bundesausschuss is responsible for actual
management of the SHI. It is composed of representatives for the sickness funds and associations of
practitioners and hospitals.
4.1.3. Health Care Delivery
Traditionally, a strict distinction was made between in- and out-patient care, implying most
ambulatory physicians were not allowed to work in hospitals and accordingly, hospital physicians not
allowed to work in an ambulatory setting. Reforms since the 1990s gave raise to the existence of
more polyclinics and integrated care programs, blurring the divide between ambulatory and hospital
care.
4.2. PHYSIOTHERAPIST PROFESSION
4.2.1. Minimal Entry Requirements
The minimum entry requirement for physiotherapy education comprises at least 10 years secondary
(so-called polytechnic ) schooling. No academic degree is required as opposed to most other
European countries.
Private practitioners adhere to the criteria stipulated by the social welfare law ( Sozialgesetzbuch V, §
124 Abs. 2 ). In accordance to the law registered physiotherapists should have completed the
minimally required training, dispose of the medical equipment specified by guidelines and accept the
general agreements ( Heilmittel-Richtlinien ) that have been agreed upon by sickness funds and
professional associations.
Membership of professional associations for SHI-accredited physiotherapists is mandatory in
ambulatory care. Three national professional associations, with regional affiliate associations, are
active in Germany:
Bundesverband selbständiger Physiotherapeuten (IFK)
Deutscher Verband für Physiotherapie (ZVK)
Verband Physikalische Therapie (VPT)