What is the role of government?
Since 2009, health insurance has been mandatory for all citizens and permanent residents of Germany (previously,
certain populations could choose not to have insurance, though few did so). It is provided by competing,
not-for-profit, nongovernmental health insurance funds (called “sickness funds”; there were 134 as of January
2013) in the statutory health insurance scheme (SHI), or by voluntary substitutive private health insurance
(PHI). States own most university hospitals, while municipalities play a role in public health activities and own
about half of hospital beds. However, the various levels of government have virtually no role in the direct delivery
of health care. A large degree of regulation is delegated to self-governing associations of the sickness funds
and the provider associations. The most important body is the Federal Joint Committee, created in 2004 (see
below).