Structural problems in the German health care system have grown to become more and more noticeable in people’s life reality – for patients as well as for employees in the individual health sectors. Staff shortages, budget constraints, long travel distances to treatment facilities, excessive bureaucracy, and an overall lack of possibilities to address individual cases all make the recovery process significantly more difficult. The experiences faced by both patients and healthcare workers in everyday clinical practice emphasise the urgent need for action. Particularly people living in rural areas are increasingly confronted with obstacles when it comes to accessing reliable medical care.
What are the underlying causes of the current situation in rural healthcare – and how can we best deal with them?
Current figures
Medical possibilities make enhance people’s longevity. Demographic change is also reflected in the growing number of patients requiring medical care. Many people need more comprehensive treatment due to chronic conditions, which tend to increase with age. At the same time, there is a lack of new professionals entering primary care, as highlighted in a report published in the German Federal Health Bulletin:
Looking at the sociodemographic situation, it becomes clear that one in three general practitioners is now aged 60 or older. […] Calculations show that around 1,700 general practitioners leave the profession each year, while the number of newly certified specialists ranges between 1,300 and 1,400. Although the latter figure has recently increased again, the need for compensation to maintain existing care capacities has remained unmet for quite some time. […]
— Wangler, Jansky
As a result of these trends, a deficit of up to 23,000 full-time general practitioner equivalents by 2030 is considered possible – particularly affecting rural and structurally weaker regions, according to Wangler and Jansky.
Why do we have to wait so long for medical appointments?
This issue runs through all areas of rural healthcare – not only is access to general practitioners limited, but waiting times of up to a year for specialist appointments can last up to a year. A shortage of skilled professionals is not the only reason here, but rather one of several contributing factors, with bureaucracy playing a key role as well. Treatment pathways are often long because patients have to visit multiple institutions just to obtain the necessary documentation.
Structural problems in the German healthcare system
It may be tempting to link such challenges in everyday medical care to individual cases. However, it is reasonable to assume that most shortcomings are rooted in structural causes rather than bad intentions. The authors of a scientific publication on medical undersupply from 2025 locate the core of the problem within the structures of the healthcare system itself:
“There is broad agreement that the greatest structural problem in the German healthcare system lies in its sector-based organisation and financing. Despite numerous initiatives aimed at ‘integrated care,’ dating back to the Health Care Structure Act of 1992/93 (which introduced early case-based payments alongside outpatient surgery and pre- and post-inpatient care), lasting and effective integration has failed due to persistent sectoral egoisms driven by separated budgets. Any effective approach to combating medical undersupply would therefore need to start here.”
– Author Group Health
The term “sectoral egoism” refers to the fact that individual sectors or institutions, acting in their own economic interests, do not prioritise effective cross-sector collaboration when financial resources are allocated. This lack of clear coordination leads to understandable frustration on the patient side.
What would need to change at a structural level?
According to expert opinion, simply increasing staff numbers is not enough to address medical undersupply. In other words:
“Undersupply cannot be avoided or eliminated solely by expanding capacities. Instead, it requires a strategic approach that takes regional needs into account, reduces bureaucracy, and promotes cooperation between general practitioners, specialists, different professional groups, and patients themselves.”
– Author Group Health
In addition, health policy debates often lack clearly defined goals.
What actions are currently being taken?
Rural doctor quota
To counteract regional medical undersupply, most German federal states, such as Baden-Württemberg and Bavaria, have introduced a so-called rural doctor quota. Under this model, prospective medical students are admitted on the condition that they commit to working as rural doctors after completing their studies.
Financial Incentives
Doctors practicing in underserved or at-risk rural areas receive financial support. According to the German Bank for Pharmacists and Physicians, these incentives are showing positive effects. Individual federal states offer various forms of financial support to attract rural practitioners.
New models of care
New forms of healthcare delivery are being implemented to improve access in rural regions. These include telemedicine as well as treatment in so-called Medical Care Centers (MVZs), where physicians from different specialties work under one roof. This model is particularly beneficial for rural patients who would otherwise face long travel distances.
What options do we have as patients?
Conversations about structural problems can leave people feeling helpless and overwhelmed. While it may be true that structural problems can only be resolved at a structural level, the question of individual agency in everyday life remains.
How do I get to the doctor if I have limited mobility?
Distance is a crucial factor, especially in rural areas. The nearest medical practice or pharmacy is not always close by, requiring a certain level of mobility. If mobility is limited, transportation services can help. In Germany, support is available through organisations such as the German Red Cross (DRK), the Johanniter, or the Malteser. If there is a medical indication, health insurance usually covers the costs.
How do I find a new general practitioner?
The website arztsuche.116117.de allows users to search for doctors by entering their postal code. Alternatively, telephone support is available via the number 116117. Platforms such as Doctolib or jameda can also be used to search for doctors in the area.
What if I need medication and there is no pharmacy nearby?
Over-the-counter medications can be purchased from licensed online pharmacies such as Shop Apotheke or DocMorris. In Germany, it is also possible to order prescription medications online by submitting the required prescription.
Final thoughts
Various approaches are currently being pursued to address demographic changes such as the aging population in rural areas (and the associated increase in demand for medical care). However, it will take time before a sustainable restructuring of the rural healthcare system produces tangible results. In the meantime, patients are faced with the challenge of organising large parts of their healthcare independently, using the resources available to them. Digitalisation creates new possibilities here, allowing us to expand our options beyond geographical boundaries. However, individual responsibility is no substitute for systemic responsibility; and we can safely leave the latter where it belongs.
Sources:
Autorengruppe Gesundheit. Unterversorgung im deutschen Gesundheitswesen – das unterschätzte Problem. Monitor Versorgungsforschung, April 2025. ➡️ Link
Doctolib. (2024, 15. Februar). MVZ – Vorteile und Nachteile. Doctolib Pro - Deutschland. ➡️ Link
Kaus, R. (2025, 26. September). Landarztquote: wichtige Infos & Studienbestimmungen. praktischArzt. ➡️ Link
Konnegen, I. (2025, 20. März). Arbeit als Landarzt/-ärztin: Übersicht der Fördermöglichkeiten. praktischArzt. ➡️ Link
Wangler, J., Jansky, M. (2024, 11. Juni). Sicherstellung der hausärztlichen Versorgung in Deutschland - Befunde einer quantitativen Befragung von Allgemeinmediziner*innen. Bundesgesundheitsblatt. ➡️ Link
Widera, A. (2021, 3. März). Gesundheitsversorgung auf dem Land: Förderung zeigt erste Wirkung. apoBank. ➡️ Link