But health premiums have jumped from 11 percent of gross salary in 1977 to more than 14 percent today with only the Swiss and the Americans paying more than the Germans for healthcare.

The aim of the new reformed German health service to share the pain of reform with Germans forced to pay more out of their own pockets for medical care.

However, critics of the reforms say that they will fail to adequately wind back the contributions made by workers and employers to the health service and that additional big changes will be needed in the coming years to stem the costs of the system as the German population ages.

As a sign that the German health reform debate still has some way to go, there have now been calls for the introduction of a so-called citizen insurance scheme which could require every citizen to make contributions to the nation's hard-pressed public health insurance groups.

This includes many public sector employees and the self-employed who are at present are able to take out private health cover. Private health insurance is also popular with expats living in Germany for a specific period. If you want to follow the private health insurance route it pays to shop around before settling on a fund as many offer policies and benefits that are tailored to people living in the country for a limited period.

All students in Germany are required to have health insurance. This means that you will have to provide proof of your health insurance cover in Germany before you can register at a university or college.

In general those working for German companies will find that their employers arrange their health insurance cover.

Employers and employees each pay half of a member's premiums, which is at present is 14.3 percent of an employee