| Verified against primary record | |
| Prior authorisation requests (2023) | 3,910 received, 3,179 authorised, 731 refused[1] |
|---|---|
| Reimbursement requests (2023) | 164,143 received, 143,814 granted, 20,319 refused[1] |
| Amount reimbursed, authorised care (2023) | EUR 7,589,767[1] |
| National hospital diagnosis series | Last published for reporting year 2016, since discontinued[5] |
| Independently reported | |
| EU patients using the Directive each year | About 200,000, under 0.05 per cent of EU citizens[3] |
| Bands apply only to the rows beneath them. The German totals are counts of insurance claims, not of patients, and the European Commission records that they include cases falling outside Directive 2011/24/EU, among them care received in Switzerland and persons resident in other EU, EEA or Swiss states. No German statistic counts foreign-resident hospital patients as a separate category. No typical cost range is given because no official German source publishes prices paid by foreign patients. | |
Medical tourism in Germany covers both the treatment of patients who travel to Germany for medical care and the treatment of German residents who travel abroad. Germany processes a larger volume of cross-border healthcare claims than any other European Union member state, and it is among the most frequent countries of treatment for care that requires prior authorisation. The published figures describe insurance claims rather than patients, and no German statistic counts foreign-resident hospital patients as such.
Official statistics
Germany reports annually to the European Commission under Directive 2011/24/EU. For reference year 2023 it recorded 3,910 requests for prior authorisation, of which 3,179 were authorised and 731 refused, and 164,143 requests for reimbursement of care not subject to prior authorisation, of which 143,814 were granted and 20,319 refused. The amount reimbursed for care subject to prior authorisation was 7,589,767 euro.[1]
Those are the largest national totals in the collection. They are not, however, a count of people who used the Directive. The Commission records that the German figures include cases beyond the Directive, including stays in Switzerland and persons resident in other EU, EEA or Swiss states, and the report notes more generally that a few countries still struggle to separate requests made under the social security coordination Regulations from requests made under the Directive. The same report warns that authorised and refused counts do not always add up to the number received, because a request can be processed in a later year.[1]
Germany’s national hospital diagnosis series, Diagnosedaten der Patienten und Patientinnen in Krankenhaeusern, records place of residence among the characteristics collected when a patient is discharged. The published series was last issued for reporting year 2016 and has since been discontinued.[5]
At European level, Eurostat runs a dedicated collection of hospital discharges of non-residents, with separate tables for in-patients, day cases, bed days and average length of stay. Its reference metadata, last updated on 15 December 2025, defines a non-resident as a person who is not a resident of the reporting country and states that country of residence is reported for non-resident patients, while noting that some countries cannot supply it and instead report the location of the hospital or record the country of residence as unknown. The metadata also cautions that EU aggregates cannot be cleanly split by residency, because a non-resident of one member state may be a resident of another. Individual cell values for Germany were not retrievable for this article.[2]
Legal framework
Cross-border care within the European Union rests on two parallel routes. Under Directive 2011/24/EU, the member state of affiliation must reimburse cross-border care where the treatment is among the benefits it covers domestically, and reimbursement is capped at the level of costs the home state would have assumed, without exceeding the actual cost of the care received. A home state may choose to pay more. Prior authorisation may be required only for defined categories of care: care subject to planning requirements that either involves an overnight hospital stay or requires highly specialised and cost-intensive infrastructure, care involving treatments with a particular risk, and care from a provider raising serious concerns about quality or safety.[4]
The second route, the social security coordination Regulations, is older, larger and separate. Figures produced under one route cannot be added to figures produced under the other, and the Commission’s own data report shows that several member states, Germany among them, do not fully separate the two in their returns.[1]
Patients treated in Germany
Germany is one of the two most frequent countries of treatment for care requiring prior authorisation, recorded alongside Czechia in the Commission’s 2023 figures. The report identifies the movement from Luxembourg to Germany as one of the busiest authorisation flows, places Germany among the destinations for patients from Italy, and names the movement from Denmark to Germany as one of the busiest reimbursement flows. Patient mobility under the Directive is overwhelmingly between neighbouring states rather than long-distance travel.[1]
These flows describe reimbursed care arranged through public systems. They do not capture patients who pay privately, who are not counted in the Directive returns and for whom no national German figure was located.
German residents treated abroad
The 164,143 reimbursement requests Germany recorded for 2023 are the largest national figure reported, and amount to more than a third of the 449,069 requests received across the 24 reporting countries. Germany also accounted for 3,910 of the 5,973 prior authorisation requests received across the 11 countries that reported them.[1]
Set against the size of the German system, the volumes remain small. The European Court of Auditors estimated that about 200,000 patients a year use the Directive across the Union, fewer than 0.05 per cent of EU citizens, and that spending under it amounts to roughly 0.004 per cent of the Union’s annual healthcare budget. The same report found that fewer than 20 per cent of citizens surveyed in 2015 were aware of their cross-border healthcare rights, and that fewer than half of national contact point websites explained that two separate routes to treatment abroad exist.[3]
Limits of the evidence
Three limits apply to any statement about the scale of medical travel involving Germany. The Directive returns count administrative claims, not people, and a single patient may generate more than one. The German returns mix Directive cases with cases arising under other instruments, so the headline totals overstate Directive use by an unknown margin. And privately funded treatment, which is what the term medical tourism most often describes in commercial usage, falls outside every official series identified here, including the discontinued national diagnosis statistics.
See also
- Cross-border healthcare, the legal and administrative framework these German figures are produced under
- Medical tourism in Belgium, a neighbouring state that does count foreign-resident hospital patients directly
- Government-funded treatment abroad, the category most of the reimbursed German caseload falls into
- Hospital discharge data in medical tourism, the source type behind the Eurostat non-resident collection
- Medical tourism statistics, why claim counts and patient counts diverge
References
- European Commission, Directorate-General for Health and Food Safety. Data on cross-border patient healthcare following Directive 2011/24/EU, reference year 2023. 15 May 2025. Verified against primary record: the report was opened and the German rows for prior authorisation, reimbursement and amounts reimbursed were read directly, together with the stated caveats on what the German figures include. Retrieved 23 October 2026.
- Eurostat. Hospital discharges and length of stay for inpatient and curative care (hlth_hosd), reference metadata. Last updated 15 December 2025. Verified against primary record: the metadata page was opened and the definition of a non-resident, the statement that country of residence is reported, and the list of non-resident tables were read. Retrieved 23 October 2026.
- European Court of Auditors. Special Report 07/2019: EU actions for cross-border healthcare. 2019. Verified against primary record: the report was opened and the figures for annual patient numbers, share of citizens, share of healthcare spending and citizen awareness were read. Retrieved 23 October 2026.
- European Parliament and Council. Directive 2011/24/EU, Chapter III, Articles 7 and 8. 9 March 2011. Verified against primary record: the chapter text was opened and the reimbursement rule in Article 7 and the three permitted grounds for prior authorisation in Article 8(2) were read. Retrieved 23 October 2026.
- Statistisches Bundesamt. Diagnosedaten der Patienten und Patientinnen in Krankenhaeusern. Reporting year 2016. Verified against primary record: the publication entry was opened, confirming that place of residence is among the characteristics recorded at discharge and that the series was last published for reporting year 2016 and subsequently discontinued. Retrieved 23 October 2026.
Sourcing note: this entry uses only official sources. No figure for privately funded treatment of foreign patients in Germany was located in any official publication, and none has been estimated here. The Eurostat non-resident collection is cited for its existence, definitions and structure; its individual cell values could not be retrieved, so no values from it are quoted. The German totals reported to the European Commission are claim counts that the Commission itself describes as including cases outside Directive 2011/24/EU, and they are presented on that basis rather than as patient numbers.