The German social health care system is the oldest in the world and coined the name of the Bismarck system of social health insurance. Germany’s healthcare system provides universal health coverage for a wide range of benefits, and health insurance has been mandatory for all citizens and permanent residents since 2009 through either statutory of private health insurance (SHI or PHI). In international terms Germany has a generous basket of benefits, one of the highest levels of capacity, and relatively low cost-sharing. In 2017, 89 per cent of the population were covered by one of the SHI’s sickness funds, while 11 per cent were covered by PHI. The introduction of quality improvement measures has started to address issues relating to the quality of care. The division between SHI and PHI remains a challenge for the German healthcare system, leading to inequalities, redundancies and obstacles to coordination.