Why Germany hospital prices are lower
Germany sets one hospital price — a DRG, a tariff, or a budget. The hospital takes it. It cannot charge each plan a different secret multiple. In the US the must-have hospital extracts 2–3× Medicare from job plans that cannot walk. The insurer passes that through. It does not set it.
G-DRG inside state budgets
How it works
Statutory insurance (SHI) pays hospitals on G-DRGs. States plan hospital capacity. Outpatient doctors use one EBM fee schedule for everyone. A small private slice exists; it does not set 3× rates for the rest of the country.
Why it holds
The hospital bills a DRG, not a chargemaster. It cannot write a different secret multiple for each fund. Same sepsis, same ICU — a German night. That is why the hospital index lands near 38¢, in the same neighborhood as France.
The invoices
See iFHP, RAND hospitals, Papanicolas.