The Health and Social System in Germany – An Overview for Study and Practice

PART 1 – From rights to reality: access in the segmented system

Why rights alone are not enough

The German social system is comprehensive but highly branched. In the previous modules you have seen how many bodies can be involved: health insurance funds (Krankenkassen) and long-term care insurance funds (Pflegekassen), rehabilitation agencies, Jobcentres and social welfare offices (Sozialämter). You know the basic idea behind this from Module 1: the welfare state principle (Sozialstaatsprinzip) creates an obligation to provide social protection, and assigning benefits to the logic of insurance (Versicherung), needs-based assistance (Fürsorge) or state provision (Versorgung) helps you to understand them. Between the abstract entitlement and the decision notice (Bescheid) on the kitchen table, however, lies a path: people need to know about an entitlement, find the right agency, submit an application, provide documents and be able to make sense of a decision. Anyone who cannot walk this path has a right on paper, but not in their hands.

The law recognises this problem. It explicitly gives every person a right of access to social insurance (section 4(1) SGB I) and assigns benefit agencies duties of public information, advice, information and referral, and accepting applications (sections 13–16 SGB I). These provisions are the legal basis of what professional practice often calls the ‘navigator role’ (Lotsenfunktion). This module draws together the threads of the first seven modules: it shows how you can translate your knowledge of responsibilities, benefits and procedures into concrete support – and where this support reaches its limits.

Definitions: access, advice, referral knowledge, navigator role

Before we use these terms, we will define what they mean in this course. Access here means the actual possibility of recognising, claiming and enforcing an existing entitlement under social law. The right of access to social insurance is laid down in section 4(1) SGB I; in a broader sense, however, access also covers the needs-based assistance benefits you know from Module 7. Advice (Beratung) is a legal entitlement in German social law: ‘Everyone is entitled to advice on their rights and obligations under this Code’ (section 14 SGB I; own translation). Responsibility lies with the benefit agencies against which the rights are to be claimed or towards which the duties are to be fulfilled.

Referral knowledge (Verweiswissen) means knowing which body is responsible for which need, where an application belongs and which point of contact can help – it is the practical fruit of the logic of responsibilities from Module 3. Finally, the navigator role is not a legal term but a professional description. It refers to the task of practitioners to guide people through the system: informing, structuring needs, referring them to the right agency, connecting services and, where necessary, advocating for the rights of those seeking advice. It is important to draw the line on two sides: the navigator role replaces neither the statutory advice provided by the benefit agencies nor legal advice in individual cases. It makes rights accessible; it does not decide on them.

Five typical access barriers

Access barriers are not isolated cases of personal failure but features of the interplay between the system and a person’s life situation. Five groups come up particularly often in advice work. Lack of knowledge: people do not know that they have an entitlement or that there is any body at all for their concern. Complexity: responsibilities are spread across several agencies, forms and technical terms are hard to understand, and applications require documents from different sources. Language and education barriers: officialese (Amtsdeutsch), foreign words and a lack of confidence in reading or writing make every step harder. Shame: anyone who has to ask for help often feels this is an admission of their own failure – especially with needs-based assistance. Digital barriers: where applications are to be submitted online, access, devices or practice are sometimes lacking.

The barriers rarely occur alone; they reinforce each other. An exhausted family carer who hardly has time for phone calls is more likely to fail at a confusing online form than someone with a clear head. This course deliberately does not give reliable figures on how many eligible people do not use benefits for these reasons; such statements would need their own evidence. For practice, it is enough to recognise that you can identify barriers early and reduce them in a targeted way. The following table assigns a typical manifestation and a possible response to each barrier.

The key concept at a glance

Figure 1 shows the mind map of this module. At its centre is the navigator role; from there, five branches lead to the building blocks that we will work through one by one in the following parts: the access barriers, the statutory duties in SGB I, specialist advice under section 7a SGB XI and section 32 SGB IX, the navigation process itself and the critical appraisal. Treat the graphic as a map and return to it later to locate your knowledge.

Three orders of magnitude, three worlds of responsibility

Three key figures from earlier modules show how wide the field is in which you navigate. They do not measure access barriers; rather, they illustrate how different the worlds are between which people seeking advice move: statutory health insurance (Module 4), care at home provided by relatives (Module 5) and subsistence support (Module 7). Anyone who feels confident in one of these worlds is far from knowing their way around the next.

The first tile stands for an insurance system with contribution-based entitlements, the second for a form of care that is mainly provided by relatives, the third for the tax-funded subsistence minimum. Each of these figures stands for its own logic, its own applications and its own points of contact. Navigation means translating between these worlds.

PART 2 – Duties to advise as the legal basis of the navigator role

Public information, advice, information and referral, applications: the framework in SGB I

The General Part of the German Social Code (SGB I) provides a common framework of four duties for all areas of social benefits. They build on each other and can be read as a path from the general to the specific. Public information (Aufklärung, section 13 SGB I) is addressed to the population as a whole: benefit agencies, their associations and other public-law bodies are obliged, within their remit, to inform the public about rights and duties under the Social Code. This is about general information, still without a specific individual case.

Advice (Beratung, section 14 SGB I) is the individual entitlement of the person concerned. It relates to their rights and duties and is to be obtained from the benefit agency against which the rights are to be claimed or towards which the duties are to be fulfilled. Information and referral (Auskunft, section 15 SGB I) goes beyond the agency’s own remit: the bodies responsible under the law of the federal states (Länder) and the bodies of statutory health insurance and social long-term care insurance provide information on all social matters under the Social Code, including naming the responsible benefit agencies. In doing so, they cooperate to ensure that information is provided as comprehensively as possible by a single body (section 15(1)–(3) SGB I). Finally, submitting applications (Antragstellung, section 16 SGB I) ties in with the logic of responsibilities from Module 3: applications are to be submitted to the responsible agency, but they are also accepted by all other benefit agencies and by all municipalities. Bodies that are not responsible forward them without delay, and the application is deemed to have been submitted at the time it was received by the first body. In addition, the benefit agencies work towards ensuring that clear and relevant applications are submitted and that incomplete details are supplemented (section 16(1)–(3) SGB I).

The table summarises the duties to advise and assigns each a responsible body and an example from practice. The examples are deliberately kept general and do not constitute a review of entitlement in an individual case.

What the provisions mean for you in practice

Sections 13 to 16 SGB I place obligations on the benefit agencies, not automatically on every organisation in which you work. Whether your organisation is itself a benefit agency or merely advises and accompanies determines which duties apply to it directly; if in doubt, clarify this with your manager or the legal department. Even if your organisation is not an agency itself, the provisions are useful to you in three respects. First, you can point out to people seeking advice their entitlement to advice from the agency and encourage them to use it (section 14 SGB I). Second, you know that an application submitted to a body that is not responsible is not lost but is forwarded, and that the date of first receipt remains decisive. It is therefore sensible to document receipt, for example with a copy or a note of when and where the application was handed in. Third, section 15 SGB I provides the model of information ‘from a single source’ – a benchmark against which you can critically measure procedures in your region.

Care counselling under section 7a SGB XI: case management logic in the statute

You know the entitlement to care counselling under section 7a(1) SGB XI and its tasks from Module 5. For the navigator role, the workflow described in the statute is of particular interest: recording and analysing the need for help, drawing up an individual care plan, working towards its implementation, monitoring progress and adjusting the plan.

Professionally, this corresponds to the case management cycle: assessing need, setting goals and a plan, linking services, monitoring progress, adjusting the plan. Section 7a SGB XI is therefore a good model, including for practitioners in social services who are not care counsellors themselves. They do not replace the care counsellors’ statutory task, but they can adopt their working logic and specifically point people seeking advice to the entitlement. A further anchor for advice in long-term care insurance is the advisory visit (Beratungsbesuch) for recipients of care allowance (section 37(3), first sentence, SGB XI; Module 5). It is a good opportunity to take up open questions from family carers.

Independent participation counselling under section 32 SGB IX

The rehabilitation agencies provide advice themselves; alongside them there is the supplementary independent participation counselling, EUTB (independent participation counselling, ergänzende unabhängige Teilhabeberatung), whose features you know from Module 6: independent of benefit agencies and service providers, available even before an application and in addition to the entitlement to advice from the rehabilitation agencies (section 32(1) and (3) SGB IX).

The distinction matters for your navigation work: advice from the agency comes from the body that will later decide. Independent counselling lies outside this decision-making role. One possible interpretation is that the two services meet different needs in terms of trust; whether people seeking advice experience it this way is an empirical question that this course does not answer. As a practitioner, you can name both routes and leave the choice to the people seeking advice.

PART 3 – The navigation process: inform, refer, connect, advocate

Five steps from concern to plan

Navigation does not follow a fixed statutory procedure, but it does follow a recognisable logic. Figure 2 shows it in five steps: you first clarify the concern, then organise needs and responsibilities, enable access through clear information and support with applications, connect the bodies involved and finally secure progress. The return arrow beneath the steps is a reminder that a navigation plan is never finished: when a person’s life situation or the legal situation changes, the loop starts again. This corresponds to the cycle of monitoring and adjustment that section 7a SGB XI describes for care counselling.

Informing and enabling access

The first step after clarifying the concern is clear information. This means short sentences, one topic at a time, explaining technical terms and, at the end, checking what has been understood – for example by asking the people seeking advice to repeat the next steps in their own words. Enabling access goes further: going through forms together, pointing out entitlements to advice from the agency (section 14 SGB I), arranging language mediation where needed and supporting applications as far as possible. Keep in mind the self-determination that participation law from Module 6 also emphasises: you do not take action away from people; you expand their options for action.

Referring and connecting: the link to case management

Because the system is segmented, the right agency often has to be found and several forms of help have to be coordinated. This is where the navigator role meets case management: bundling help, bridging interfaces and keeping the common thread. A ‘warm’ handover works well here: you do not merely refer people seeking advice to a body but, with their consent and in line with your organisation’s data protection procedures, make contact in advance and pass on the essential information. Document who has promised what and when the next update is due. In this way, individual referrals become a plan that holds even if one of the people involved changes.

Advocacy: in individual cases and at the structural level

Advocacy has two levels. In individual cases, you support people seeking advice when an application is rejected: you help them understand the decision notice, inform them that legal remedies such as an objection (Widerspruch) are possible, and refer them to the advice and legal services responsible for the legal questions. Take the deadlines from the decision notice and clarify them immediately with an expert body. At the structural level, you bring recurring access problems to your organisation, networks and committees: if the same form fails again and again or an interface regularly loses people, that is information for those in charge. Structural advocacy is therefore also a management task, to which we return in Part 5.

PART 4 – Reforms 2024 to 2026 and transfer to case work and term papers

Current (as of October 2026): five reform steps at a glance

Referral knowledge goes out of date quickly. Figure 3 arranges the five reform steps that play a role in this course on a timeline. Filled circles stand for law in force, the dashed circle for a draft. For navigation, what matters is less every detail than the question: where are responsibilities, terms or benefits shifting that you have mentioned in conversations so far?

What the reforms mean for advice work

The hospital reform is relevant to navigation above all because it affects the interfaces between inpatient, outpatient and nursing care. Service groups, remuneration for maintaining capacity and cross-sectoral care facilities change the landscape in which transitions of care take place; planning lies with the federal states (BMG, 2026d). An open question, to be discussed in the professional debate, is the tension between quality and accessibility, particularly in rural areas. The sources used here do not reveal what this means specifically for your region; you will need to clarify this locally.

The Act to Extend Powers and Reduce Bureaucracy in Nursing Care allows nurses, depending on their qualifications, to take on independently tasks that were previously reserved for physicians, for example in the management of chronic diseases. Which services these are in detail is laid down in contracts of the self-governing bodies (Selbstverwaltung) with the participation of the nursing professional associations. At the same time, reporting obligations in long-term care are to be reduced and shared forms of care housing promoted (Bundesregierung, 2026b). For your referral knowledge this means: watch how the contractual specification progresses before you promise people seeking advice who may take on which task.

The New Basic Income Support is based on the Thirteenth Act Amending Book II of the Social Code and Other Acts (Dreizehntes Gesetz zur Änderung des Zweiten Buches Sozialgesetzbuch und anderer Gesetze) of 16 April 2026 (Federal Law Gazette, BGBl. 2026 I No. 107). According to the Federal Government (Bundesregierung, 2026a), breaches of duty lead to a reduction of 30 per cent for three months; missed appointments are penalised from the second missed appointment onwards with a reduction of 30 per cent for one month, and after three consecutive missed appointments a graduated procedure applies, up to possible withdrawal of the benefit. In addition, there is priority for job placement combined with training, especially for people under 30, the abolition of the one-year grace period (Karenzzeit) for assets, with age-dependent protected assets, and a cap on housing costs during the grace period. You will find the details on entitlement and benefits in Module 7. The responsibility of the Jobcentres does not change as a result, but the name and rules of the benefit do.

The reform is assessed in different ways, and you should know both lines of argument without taking sides. Supporters emphasise the greater commitment required and the focus on job placement and training. Critics point out that reductions place a strain on advice relationships and can particularly affect people facing access barriers. Both are interpretations and expectations; this course lacks the evidence for reliable statements about effects. For your practice, this results above all in an advisory task: informing people seeking advice clearly about their duties to cooperate and about appointments, without providing individual advice on legal consequences.

The draft Long-Term Care Reorganisation Act (officially: Gesetz zur Neuordnung der Pflegeversicherung, Act on the Reorganisation of Long-Term Care Insurance) was adopted by the Federal Cabinet on 30 September 2026; a ministerial draft had been available since June 2026. According to the BMG (2026c), plans include an adjusted eligibility assessment system (Begutachtungssystematik) with protection of existing status for people already assigned a care grade, higher care allowance and benefits in kind in care grades (Pflegegrade) 2 to 5, a community-based budget (Sozialraumbudget) instead of the relief amount (Entlastungsbetrag) from care grade 2, a higher contribution surcharge for childless people (planned 0.9 per cent from 1 January 2027), a contribution surcharge for co-insured spouses or civil partners (planned 0.52 per cent from 1 January 2028), clarification according to the principle of ‘rehabilitation before care’ (Reha vor Pflege) and a digital ‘Pflege-Cockpit’ (care cockpit). All of this is a draft. Do not advise people seeking advice to base their decisions on planned rules, and clearly mark drafts as such in your materials.

Worked example: the structure in five steps

For complex cases – in timed written papers at university, term papers or case discussions in the team – a fixed framework helps. It prevents you from mixing up provisions, agencies and measures. The structure is called ‘legal basis – responsibility – benefit – access barrier – action step’ and is shown in Figure 4. First you see the structure in general terms, then it is worked through in full using a case; only after that comes your own exercise.

The case: Lina Walter is 79 years old, lives in her own flat and has care grade 3. She receives care allowance; her son Elias Walter provides most of her care. He is exhausted and asks at a social advice service what he is entitled to and who can give him some relief. Online forms overwhelm him.

1. Legal basis: As a recipient of long-term care insurance benefits, Mrs Walter is entitled to care counselling (section 7a(1) SGB XI), which also provides information on relief services for carers. In addition, there is the advisory visit for recipients of care allowance (section 37(3), first sentence, SGB XI) and the general entitlement to advice and to information and referral (sections 14, 15 SGB I).
2. Responsibility: The point of contact is the long-term care insurance fund (Pflegekasse) as the body of social long-term care insurance; under section 15 SGB I it is also obliged to provide information on other responsible benefit agencies.
3. Benefit: For care grade 3, care allowance amounts to 599 euros per month (section 37(1) SGB XI, amounts since 1 January 2025). Crucial for Mr Walter: the counselling and the care plan, not just the cash benefit.
4. Access barrier: Mr Walter does not know about the entitlement to advice, is exhausted, and the digital forms make it harder to get in touch (lack of knowledge, complexity, digital barrier).
5. Action step: With Mrs Walter’s consent, the practitioner points out the entitlement to care counselling, notes down questions and burdens together with Mr Walter and supports him in arranging an appointment with the long-term care insurance fund. She records when contact was made and agrees a follow-up date. Legal questions, for example about a rejection, go to the responsible advice or legal services.

As you read, note that each step builds on the previous one: without the legal basis, the responsibility remains an assertion; without the access barrier, the action step remains abstract. You can use exactly this linkage in your own texts.

Transfer to the term paper

For students, the structure can be used directly as a framework for a text. The legal basis forms the legal framework, responsibility clarifies the actors, benefit and access barrier form the analytical core, and the action step establishes the link to practice. Add a chapter on limits and open questions, as shown in Part 5. Pay attention to referencing discipline: cite statutes in the official version with the date of the legal status, give figures with the reference year, mark drafts as drafts and do not claim effectiveness that has not been demonstrated.

PART 5 – Critical appraisal: equity of access, limits and tensions

Equity of access in the segmented system

The law sets out as its guiding model information that is as comprehensive as possible from a single body (section 15 SGB I). This indicates that the segmentation of the system itself is recognised as a problem. Whether this model is realised in practice is an empirical question on which this course makes no statement. From a professional perspective, two positions can be distinguished. The first sees segmentation as historically evolved specialisation which, although complex, enables precisely targeted benefits; the answer to complexity would then be better coordination and advice. The second sees complexity itself as a cause of inequality in access and calls for simplification and fewer interfaces. Both positions can be justified and they are not mutually exclusive.

Limits of the conservative social insurance state

As you know from Module 1, Schmid (2020) assigns Germany, in Esping-Andersen’s typology, to the conservative continental European type, whose social rights are tied to status and strongly geared towards social insurance and paid employment. For the topic of access, an interpretation can be derived from this which should be understood as a hypothesis, not a finding: people with a continuous employment history probably find it easier to move within the familiar channels of social insurance than someone whose life situation depends on subsidiary needs-based assistance (on subsidiarity, cf. section 2(1) SGB XII). The opposing view points out that insurance entitlements exist precisely without a means test and can therefore be less stigmatising than means-tested benefits of the kind Schmid (2020) describes for the liberal type.

Limits and risks of the navigator role

First: role boundary. Practitioners do not provide legal advice in individual cases. They inform, structure and accompany, and refer legal questions to benefit agencies, advice services or legal services. Second: the compensation trap. If navigation only serves to compensate for the complexity of the system, it risks relieving the pressure for reform. Structural advocacy, i.e. reporting access problems back to those in charge, is therefore not an extra but part of the task. Third: knowledge decay. The reforms in Figure 3 show how quickly referral knowledge can become outdated. Fourth: role conflicts. Practitioners work in organisations with their own goals and resources; the independence of participation counselling under section 32 SGB IX shows that the legislature also regards conflicts of interest as relevant. Fifth: effectiveness. Whether and to what extent advice, case management or navigation actually improve access is not quantified here; such statements need their own empirical evidence. Case narratives such as those in this module illustrate the logic of action; they do not prove an effect.

Consequences for management and open questions

For managers, all of this results in a mandate to shape conditions. Referral knowledge should not depend on individual people but be anchored in overviews of responsibilities, case rounds and induction concepts, with the date of the legal status and drafts kept separately. Feedback on access problems needs a route to management and from there into networks and committees. Clarify employment, data protection and procurement law with the legal department, the staff representative body (Mitarbeitervertretung) or specialist advisers. Questions that this course deliberately does not answer remain open: how can the success of navigation be measured? Which barriers have the strongest effect in your region? And how much simplification of the system would be compatible with its segmented structure?

For your working day

• ☐ Do I have a responsibility sheet for my most frequent concerns, with legal provision, body, contact route and date of the legal status?
• ☐ Do I point out to people seeking advice their entitlement to advice from the agency, and care counselling or independent participation counselling where these fit?
• ☐ Do I document when and where applications were handed in?
• ☐ Do I clearly mark drafts and planned reforms in my materials as drafts, with their status date?
• ☐ Do I know where to refer legal questions in individual cases, and do I know my organisation’s procedures for this?
• ☐ Is there a route for reporting recurring access problems back to my manager?

Self-reflection – 5 questions

Voluntary · not graded – your answers are not saved and are not evaluated by anyone. Click an answer; the explanation helps you assess your own understanding.