Name: 德國的免費醫療迷思：瀕臨崩潰的醫療體系內幕 | DW News (The myth of free healthcare in Germany: Inside a system at breaking point | DW News)
Uploaded: 2026-03-09T17:32:34.000Z
Duration: 13 min 58 s

This clinic in Hamburg is open to everyone, including people who have no health insurance.

這間位於漢堡的診所對所有人開放，包括沒有健保的人。

Official numbers show that around 70,000 people in Germany are uninsured, and

官方數據顯示，德國約有七萬人沒有保險，

情態助動詞 B1

So in a country that's known for its universal health care, how do these people get medical treatment?

那麼，在一個以全民健保聞名的國家，這些人要如何獲得醫療照護呢？

Germany has one of the world's most expensive healthcare systems, but

德國擁有世界上最昂貴的醫療保健系統之一，但

the quality doesn't always match the price tag.

At the same time, many hospital beds remain unchecked, underused, and bureaucracy is inefficient.

同時，許多病床未受檢查、未被充分利用，而且官僚體系效率低下。

We pay for Mercedes, but we drive a Golf.

我們付了賓士的錢，卻開高爾夫球車。

We are really in a relatively bad situation, which I haven't seen for many decades.

我們現在的處境真的很糟，已經幾十年沒見過了。

The German Hospital association has even called 2026 a schicksalz year, a make or break year for the healthcare system.

德國醫院協會甚至稱 2026 年是 schicksalz year，是醫療保健系統的 make or break year。

And the government is promising to implement a major healthcare refor.

政府也承諾將實施重大的醫療保健改革。

Minister Nina Wacken didn't sugarcoat it.

部長 Nina Wacken 並沒有粉飾太平。

We're dealing with inefficient structures, unsustainable financing, staff shortages, poor digitalization and way too much bureaucracy.

我們面臨著效率低落的結構、不可持續的財務、人手短缺、數位化不足以及過多的官僚主義。

So what exactly is going wrong and what are possible ideas for solutions?

那麼，到底哪裡出了問題，又有哪些可能的解決方案呢？

Germany has the most expensive healthcare system in the EU.

德國擁有歐盟最昂貴的醫療保健系統。

In 2023, the country spent around 12% of its GDP for healthcare, more than any other country in the European Union.

2023 年，德國在醫療保健方面的支出約佔 GDP 的 12%，高於歐洲聯盟中的任何其他國家。

However, in terms of avoidable deaths, its performance is just average.

不過，就可避免的死亡人數來看，它的表現僅是平均。

In Germany, more than 83 deaths out of 100,000 inhabitants were considered avoidable.

在德國，每十萬居民中有超過 83 人死亡被認為是可避免的。

In Sweden and the Netherlands, it was less than 60 deaths.

在瑞典和荷蘭，這個數字不到 60 人。

Already, 25 years ago, the WHO produced a first international ranking, where we at that time were third expenditures, but

早在 25 年前，世界衛生組織就做出了第一個國際排名，當時我們的支出排第三，

但成果卻是排在第 21 或 22 名。

And at that time, the then chairperson of the Academic Advisory Board to the Ministry made his famous sentence.

當時，部會的學術諮詢委員會主席就說出了他那句名言。

We pay for a Mercedes, but we drive a Golf in healthcare.

我們付的是賓士的價格，開的卻是高爾夫的醫療。

But what makes it so expensive and so inefficient?

但究竟是什麼讓醫療保健系統如此昂貴又如此沒效率呢？

Here are some of the common talking points.

An increasingly aging population, an inefficient system of hospitals and clinics with too many beds and low occupancy.

人口老化越來越嚴重，醫院診所繫統效率不彰，床位過多但使用率偏低。

Many unnecessary doctor visits and treatments often done in hospitals instead of an outpatient basis.

許多不必要的門診和治療，常在醫院進行而非門診。

Rising costs for medications and treatments, and broad healthcare coverage and benefit packages.

藥品和治療費用不斷上漲，以及廣泛的醫療給付範圍和福利方案。

But what do these rising costs actually mean for the average person and for the economy as a whole?

但這些不斷上漲的費用，對一般民眾和整體經濟來說，到底意味著什麼呢？

To answer that, we first need to understand how Germany's healthcare system is funded in the first place.

為了回答這個問題，我們首先需要了解德國的醫療保健系統究竟是如何被資助的。

Most people, nearly 75 million, are covered by public insurance.

大約七千五百萬人，也就是大多數人，都由公共保險涵蓋。

Half of Health insurance contributions are financed by employers and half by employees.

健康保險保費由僱主負擔一半，員工負擔一半。

These contributions have risen steadily in recent years.

近年來，這些保費持續穩定上漲。

In 2026, an average of 70.5% of gross wages will go toward health insurance, regardless of your health status or age.

到了2026年，平均將有70.5%的總薪資用於健康保險，這與您的健康狀況或年齡無關。

This applies to everyone with statutory health insurance.

這適用於所有擁有法定健康保險的人。

Uniquely in Germany, you can completely opt out of this system.

在德國，你可以完全選擇退出這個系統，這是德國獨有的。

Around 8.8% of people in Germany have private insurance, mainly high income earners, the self employed and freelancers, which drains financial resources from the statutory system and contributes to the problem.

德國大約有 8.8% 的人擁有私人保險，主要是高收入者、自營業者和自由工作者，這會從法定系統中耗盡財政資源，並加劇問題。

The insurer's expenses continue to rise while their revenues decline.

保險公司的支出持續上升，而收入卻在下降。

In 2026, insurers face a 2 billion euro shortfall.

到了 2026 年，保險公司將面臨 20 億歐元的資金缺口。

By 2027, that gap could explode to 12 billion.

到了 2027 年，這個缺口可能會飆升至 120 億。

One more reason for that, the demographic change.

另一個原因是人口結構的變化。

The number of patients as a percentage of patients above 70, above 80 years old, will considerably increase, and

70 歲以上、80 歲以上的病患比例將顯著增加，

that is putting additional pressures on the expenditure side.

這對支出方面造成了額外的壓力。

Germany has one of the highest amounts of hospitals per capita in Europe.

德國每百萬人口擁有的醫院數量是歐洲最高的之一。

This ensures good access to care, but also creates significant inefficiencies.

這確保了良好的就醫管道，但也造成了顯著的效率低下。

We have among the highest numbers of beds per 10,000 patients, and

我們每萬名病患擁有的病床數是歐洲最多的之一，

we are using these beds extensively in international comparisons.

而且相較於國際標準，我們對這些病床的使用率非常高。

It's demonstrated in many areas that we do treat patients within a full hospital stay, where other countries far more come and do it without a hospital stay in the ambulatory setting.

許多領域都顯示，我們會讓病患在醫院內完成治療，而其他國家則有更多是在門診環境下完成，無需住院。

And the costs for this care are increasing.

而這些照護的成本正在不斷增加。

With new breakthrough treatments on the horizon, the system is under even more pressure.

隨著新的突破性療法即將問世，整個系統承受著更大的壓力。

At the same time, we see that in the drug industry, in the medical device industry, there is a lot of progress being offered.

同時，我們也看到在製藥業、醫療器材業，都有許多進步正在發生。

Yeah, I mean, if you look at Alzheimer, if you look at cardiovascular diseases, there are some breakthrough therapies approaching.

沒錯，看看阿茲海默症，看看心血管疾病，都有一些突破性的療法即將問世。

But then the question is, can we afford to be as generous as in the past to really fund all these therapies?

但問題是，我們還能像過去一樣慷慨地支付所有這些療法嗎？

According to an OECD poll, Germans in 2023 went to the Dr. 9.7 times on average.

根據經濟合作暨發展組織（OECD）的調查，德國人在2023年平均看了9.7次醫生。

This is more than the OECD average of 6.5.

I think there is an overuse because people are used to go to the physicians very regularly and very often.

我認為這是過度使用，因為大家習慣了非常規律且頻繁地去看醫生。

It's also an incentive aspect from the provider side, because the remuneration system, the fee schedule for physicians, rewards that people come back.

從提供者這邊來看，這也是一種誘因，因為醫師的報酬制度、收費標準鼓勵病患回診。

You fill your offices regularly by inviting them to come back.

你們透過邀請病患回診，讓診間經常客滿。

That's part of the business model of physicians.

這也是醫師商業模式的一部分。

On average, the waiting time for an appointment with a specialist In Germany is 36 days.

在德國，預約專科醫師的平均等待時間是36天。

This is one of the things bothering people with statutory health insurance the most.

這是讓強制性醫療保險的民眾最頭痛的問題之一。

For some people, the problem isn't the waiting time, it's getting any treatment at all.

有些人遇到的問題不是等待時間，而是根本沒辦法看醫生。

There are people who have no insurance coverage whatsoever.

有些人是完全沒有任何保險給付的。

If the economy is in a crisis, then the number of people without health insurance is increasing as well, because then you are falling out of the labor market.

如果經濟陷入危機，沒有健康保險的人數也會跟著增加，因為你就會失去工作。

then the likelihood that you lose your health insurance is there, and

你失去健康保險的可能性就存在了，而且

當然，這些人是可以回來，但是

then the health insurance system wants them to pay also the lost contributions of the time when they were not in health insurance, which of course is not an invitation to come back.

屆時健保系統會要求他們補繳在沒有健保期間的保費，這當然不是一個歡迎他們回來的條件。

So what can these people do when they get sick?

所以這些人生病的時候能怎麼辦？

官方數字顯示，德國約有七萬人沒有健保，而且

所以，在一個以全民健保聞名的國家，這些人要如何獲得醫療？

Bronwyn Margolis is managing this free clinic that treats uninsured patients, people who have fallen through the cracks of the health care system.

Bronwyn Margolis 正在管理這間免費診所，為沒有健保的病患提供治療，這些人是醫療保健系統中的漏洞。

Kinder mentioned the people living on the streets and people without a secure residency status.

Kinder 提到無家可歸者和沒有合法居留身份的人。

Being uninsured is rarely an isolated problem.

沒有健保很少是個單獨的問題。

It often goes hand in hand with uncertain residency status or unstable work.

這通常伴隨著不確定的居留身份或不穩定的工作。

They don't have health insurance because, for example, they can't get work, at least not jobs that come with social insurance.

他們沒有健康保險，是因為，例如，他們找不到工作，至少找不到有社會保險的工作。

There are also many day laborers who can only work a few hours here and there.

還有很多臨時工，只能做幾個小時的工作。

And of course, their families are affected as well.

當然，他們的家人也會受到影響。

By offering multiple types of consultations, the clinic aims to address as many concerns of their patients as possible.

診所透過提供多種諮詢，希望能盡可能解決病患的各種疑慮。