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How unhealthy habits are putting pressure on Germany's healthcare system

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How unhealthy habits are putting pressure on Germany's healthcare system
Revelllers raise a beer at Oktoberfest in Munich. Photo: DPA
16:03 CET+01:00
Healthcare in Germany has been praised in a global study – but Germans are still battling bad habits.

According to the OECD Health at a Glance 2019 report, Germany is among the top five spenders on health care, both as a proportion of GDP (11.2 percent) and per person ($5,986). 

And health spending is projected to further increase to reach 12.3 percent of GDP by 2030.

The report said: “With such high level of spending, Germany guarantees good access to health care services, with a widely available health infrastructure, a high number of health professionals and relatively broad coverage for the costs of health care.”

However, Germany has mixed results when it comes to health outcomes.

Life expectancy for people in Germany is at 81.1, making it 10th in the list of developed countries and above the OECD average of 80.7, but behind Japan which snags the top sport, with a life expectancy rate of 84.2.

READ ALSO: The 20 key stats that help explain Germany today

Unhealthy habits in Germany also remain widespread. Germans on average consume more pure alcohol – 11 litres per year – than the OECD average of 8.9.

To compare with neighbouring countries, the amount of litres of alcohol consumed per year in France is 11.7,while in Austria it's 11.8, and in Switzerland it's 9.2. The countries that consume the lowest amount of alcohol are Turkey, Israel and Mexico (all under five litres).

In Germany, 60 percent of the adult population is more likely to be overweight or obese – that's higher than the OECD average of 55.6 and far greater than in France (49 percent), Austria (46.7 percent) and Switzerland (41.8 percent).

Meanwhile, the share of adults in Germany who smoke – 19 percent – is higher than on average across the OECD, although it's worse in other countries, such as France where the proportion is 25.4 percent.

READ ALSO: Opinion: Why Germany needs to take the smoking ban more seriously

Photo: DPA

Looking at the big picture, smoking rates range from over 25 percent in Greece, Turkey and Hungary, to below 10 percent in Mexico and Iceland.

Germany has a high rate of diabetes. A total of 8.3 percent of the population has diabetes, compared to the OECD average of 6.4 percent. In France, that figure is 4.8 percent, in Austria it's 6.4 and it's 5.6 in Switzerland.

Overall, the report found that 8.4 percent of the population are in poor health, slightly better than the OECD average of 8.5 percent.

Preventable deaths

The OECD researchers say that Germany's unhealthy habits, like drinking too much alcohol and smoking, are contributing to preventable deaths. 

Around 120,000 people died in Germany in 2016 from preventable causes such as lung cancer or alcohol-related causes.

The OECD said this "could be avoided through effective public health and primary prevention interventions".

While the mortality rate for these causes in Germany is 10 percent below the OECD average, it is substantially higher than in many western European countries, such as Switzerland or the Netherlands.

“Although progress has been made in reducing risky health behaviours, Germans are still more likely to smoke and consume more alcohol than the OECD average,” the report said.

“In 2017, nearly 19 percent of German adults smoked daily. This is down from 23 percent a decade earlier but still much higher than in Sweden or Norway (10-12 percent).”

The report suggested Germany take further measures to combat drinking alcohol and smoking, such as a complete ban on tobacco advertisement.

READ ALSO: Germany should take drinking tips from Scotland, experts insist

High number of doctors and nurses

Things look good when it comes to access to healthcare.

Compared to other OECD countries, Germany has a high availability of doctors and nurses. There are 4.3 practising physicians (OECD average is 3.5) and 12.9 nurses (OECD average is 8.8) per 1,000 population. 

However, there are regional differences, with rural areas less well served. When it comes to doctors, Germany has a relatively low and decreasing proportion of GPs who "play a key role in addressing the needs of an ageing population," the report said.

This comparably high supply of health workforce needs to be seen in context with the very high health care activity, particularly hospital activity. With 255 hospital discharges per 1,000 population, Germany has the highest rate of inpatient activity among all OECD countries – more than 60 percent above the OECD average. 

READ ALSO: Germans turn to 'medibus' as doctors desert villages

As a result, the workload of some health workers in Germany is high. For example, in hospitals there are fewer nurses per bed than in many neighbouring countries.

A number of policy measures to address this issue and improve working conditions of nurses have been implemented recently. These include the introduction of minimum nurse-to-patient ratios in some areas in hospitals and making additional funding available for hospitals to increase nursing staff.

Germans visit doctors more often than other countries

Germany has the fourth highest share of the population over 65 in the OECD countries, with a growing number of people affected by chronic conditions.

The report said hospitalizations in the Bundesrepublik "are high for chronic conditions such as diabetes or congestive heart failure, that should effectively be dealt with in primary health care".

Germans also consult doctors in the outpatient sector more frequently than people in most other countries. Demographics and the wide availability explain some but not all of the higher utilization rates, said the OECD.

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